早期胆管癌の1例

Early Carcinoma of the Common Bile Duct, Report of a Case

　胆管癌では閉塞性黄疸を手掛かりに診断されるものが大部分である．黄疸を発症するまでの比較的早期の段階には，特徴的な臨床症状がないために胆管癌の早期診断は極めて難しい．現状では切除例の大部分は組織学的に胆管外膜，または外膜を越えて他臓器，脈管への腫瘍の浸潤を伴う進行癌である．しかし，切除例のうち肉眼的に乳頭型，または結節型を示す例では，ときに癌の浸潤が胆管外膜に達するまでに胆管閉塞を来し，黄疸を発症するために早期に診断されることがある．われわれは肉眼的に乳頭型の所見を示し，組織学的に癌の浸潤が胆管上皮に限局した下部胆管癌切除例の検査所見および病理組織所見について報告し，更に早期胆管癌の報告例に関する文献的考察についても述べる．

　A 66-year-old man was hospitalized due to jaundice and itching. PTC demonstrated obstruction of the distal common bile duct. Percutaneous drainage of the bile ducts was immediately performed. A few days later ERCP revealed normal papilla of Vater and the pancreatic duct system. The distal common bile duct was obstructed. Angiography was performed to assess resectability of the tumor. There was no abnormality of pancreatic head vasculature or portal vein system. The patient underwent operation and pancreatoduodenectomy was performed. On a resected specimen a tumor in the distal common bile duct measured 3.0×1.0×1.0 cm. Histologically it disclosed well differentiated adenocarcinoma and the tumor was confined to the mucosa of the common bile duct.