case 2 内視鏡的膵・胆管造影で診断しえた肝癌の1例

A Case of Canser of the Liver Diagnosed by Endoscopic Pancreatocholangiography

患者：神○○○○郎　72歳　男

病歴：数力月前から全身倦怠．1週間前から38℃の発熱．抗生物質無効のため紹介され入院．

現症：肝腫大弾性硬．

　Case: a man 72 years of age.

　Present history: Since a few months before he had a feeling of lassitude. Since one week before the temperature rose to 38℃. Antibiotics were of no effet and he was referred to our hospital.

　Status praesens: The liver was swollen, elastic hard to the touch.

　Results of laboratory examinations: Serum bilirubin was 0.7 mg per 100ml alkaline phosphatase 10.4 B. L. units, GOT 20 units, GPT 20 units. Colloid reactions were all within normal limits. LAP was 300 units, γ-GTP normal, α-Fetoprotein negative. Sedimentation rate was 48 mm per hour. Red blood cell count was 3,680,000 with 8,400 white cells (differential count: st. 17%, seg. 57%, lymph. 14%, mono. 2%，baso．1%, eos. 9%), with a platelet count of 94,000. X-ray films of the gastrointestinal tract and the chest were normal.

　Endoscopic cholangiography :

　As shown in the illustrations, it was suggestive of cancer in the hepatic ducts.

　Laparoscopy: Although swollen, the liver showed no gross finding indicative of cancer. Biopsy of the liver performed is shown in Figs. 5 and 6.

　Histologic picture: Acinar architecture was destroyed, irregularly infiltrated with bundles of pleomorphic basophili ccells of various size, associated with hyperplasia of fibrous tissue. The overall picture was indicative of cholangioma.

　Discussion :

　One must be well versed in the normal picture of the hepatic ducts, paying special attention to their abnormal courses or their defects. Some measure must also be thought out to visualize the entire course of the hepatic ducts.