広汎な粘膜浸潤を伴った多発性乳頭型胆囊癌の1例

Multiple Papillary Type Carcinoma of the Gallbladder with Diffuse Mucosal Invasion, Report of a Case

　胆囊癌は最近の胆道X線検査法，超音波検査法の進歩により術前に診断される症例が増加しつつある．しかしながら，その多くは切除不能症例で予後も極めて悪い．胆囊癌の早期診断と適切な治療法の確立が急がれるところである．われわれは胆囊のほぼ全域に浸潤が認められ，早期癌に関し，示唆に富んだ症例を経験したので報告する．

　A 48-year-old woman admitted to our hospital with chief complaint of hypochondralgia. Ultrasonography revealed a protruded lesion of the gallbladder.

　Cholecystectomy with extirpation of the lymph nodes along the extra-hepatic bile duct was performed. Since cancer cell invasion in the surgical end of the cystic duct was disclosed by microscopic examination of the specimen, re-operation of bile duct resection and intra-operative irradiation were performed 20 days later.

　The patient is alive without any recurrent sign for 33 months.

　The resected gallbladder revealed multiple polypoid masses ranging 2 to 24 mm in diameter and diffuse protruded lesions of the mucosa. The polypoid masses were histologically papillary adenocarcinoma. Carcinoma was almost limited to the mucosa, and microscopically it infiltrated to the propria muscle.

　This case is interpreted as the so-called early carcinoma of the gallbladder.