胆管癌のリンパ管侵襲により十二指腸リンパ管拡張症を呈した1例

Duodenal Lymphagiectasia Due to Lymphatic Invasion by Common Bile Duct Cancer, Report of a Case

要旨　症例は73歳，男性．他疾患で前医入院時に総胆管腫瘍を疑われ入院となった．諸検査にて胆管癌と診断，リンパ節転移，他臓器遠隔転移も認めた．上部消化管内視鏡検査では十二指腸球部および下行脚に，立ち上がりなだらかで表面に散布性白点と発赤を伴う扁平隆起性病変を多数認めた．同部位の生検で，粘膜固有層および粘膜表層のリンパ管に低分化型腺癌細胞が充満し著明に拡張していたことから，内視鏡で認めた散布性白点を伴う隆起は癌のリンパ管侵襲によるものと考えられた．悪性腫瘍の転移形態として，このようなリンパ管拡張症様所見を呈しうることが示唆され，積極的に生検することが必要であると考えられた．

　A 73 year-old man was referred to our hospital for further investigation of a common bile duct tumor. A series of examinations revealed that the tumor was common bile duct cancer with metastasis to the regional lymph nodes and distal organs. Gastroduodenal endoscopy showed that there were many round, flat-elevated lesions with scattered white speckles and red spots on their surfaces extending from the duodenal bulb to the descending portion. A biopsy specimen of the duodenal tumors revealed that there were markedly distended lymphatic vessels filled with poorly differentiated adenocarcinoma cells in the mucosa and lamina propria. This finding suggested that the white-speckled appearance of the elevated lesions was due to lymphatic embolism of the bile duct cancer. A lymphatic metastatic cancer lesion may cause such lymphangiectasia, so biopsies of it should be carried out carefully.