胆道二重造影が診断に有用であった陥凹型早期胆管癌の1例

Diagnosed by Endoscopic Retrograde Biliary Double-contrast Radiography, Report of a Case

要旨　患者は48歳，男性．発熱を伴う右季肋部痛を主訴に来院．超音波検査で胆嚢結石・肝外胆管拡張，ERCPでは膵胆管合流異常・嚢胞状胆管拡張が示された．胆道二重造影で拡張胆管の一部に陥凹性病変・粘膜微細構造の消失および顆粒状変化を認め，同時に施行した胆汁細胞診の結果，Class V（腺癌）と判定された．血管造影では胆管周囲動脈叢に明らかなencasementは認められず，膵胆管合流異常に合併した胆管内に限局する陥凹性胆管癌と診断した．膵頭十二指腸切除術が施行され，病理組織学的に乳頭腺癌，深達度mと診断された．本症では早期胆管癌診断における胆道二重造影の有用性が強調された．

　A 48-year-old man was admitted to our hospital complaining of fever and right hypochondralgia. US showed dilated CBD and swelling of the gallbladder with strong echo. ERCP revealed anomalous insertion of the common bile duct into the pancreatic duct with cystically dilated bile duct. Endoscopic retrograde biliary double-contrast study was perfomed at the ERCP examination. It showed the presence of a shallow depression with mucosal convergence of the dilated bile duct. A group of adenocarcinoma cells was obtained from bile via a nasobiliary catheter. Specimen resected using pancreatoduodenectomy showed a 2.0×3.5cm-sized papillary adenocarcinoma like a Ⅱa＋Ⅱc lesion. Biliary double-contrast radiography is recommended for detection of small bile-duct cancers.