病理面からみた肝内結石症の病態

Pathological Aspects of Hepatolithiasis

要旨　肝内結石症の結石含有胆管は，拡張と相対的狭窄を示し，その基本的組織像は慢性増殖性胆管炎であり，線維増生，炎症性細胞浸潤および腺組織の増生がみられた．これら3つの基本病変は症例により，胆管のレベルにより変動を示した．そして，この増生した腺組織から分泌される粘液が肝内結石の形成，成長に何らかの役割を果たすと考えられた．肝内胆管拡張が結石形成に先行する症例があり，特に孤立性肝内胆管拡張症の検索が重要と考えられた．肝内結石症の約10％以下の症例に肝内胆管癌の合併がみられ，慢性増殖性胆管炎にみられる異型胆管上皮の過形成が胆管癌の前駆病変と考えられた．

　In hepatolithiasis stone-containing bile ducts revealed dilatation and relative stenosis, and histologically disclosed “chronic proliferative cholangitis”. The latter was characterized by fibrosis, inflammatory cell infiltration and proliferation of glandular elements. These three elements were different from case to case or at several levels of the biliary tree. Secreted mucin from these proliferated glandular elements might do much in the genesis of hepatolithiasis. Some cases might have been preceded by intrahepatic bile duct dilatation, especially solitary intrahepatic bile duct dilatation. Intrahepatic cholangiocarcinoma might complicate some cases of hepatolithiasis (＜10％), and hyperplastic atypical biliary epithelia in chronic proliferative cholangitis might be a precursor lesion of carcinoma.