いわゆる早期胆囊癌と考えられた1例

Early Gallbladder Carcinoma, Report of a Case

　近年のComputed Tomography（CT）やUltra-sonography（US）を中心とした検査法の進歩は，胆道疾患に対する診断能を飛躍的に向上させ，なかでも胆囊疾患に対する診断に著しい進歩をもたらした．しかしながら胆嚢癌，殊に早期胆囊癌の診断と予後に関しては，臨床的および病理組織学的に究明されねばならない幾つかの問題点も残されている．

　今回われわれは早期胆囊癌と考えられる症例を経験したので報告する．

　The patient, a woman 39 years of age, was diagnosed in April 1979 as having a polyp of the gallbladder after she was examined at our department because of pain in the right hypochondrium. She was placed on the follow-up list because she refused to undergo an operation.

　In February 1980 she was admitted to our hospital as the pain worsened and detailed examinations were necessary. No chronological change was noticed in the gallbladder polyp by peroral cholangiography, abdominal US, CT, etc. However, she was operated on in our department of surgery in April of the same year. As a tentative diagnosis during the surgical intervention was negative for malignancy, only the gallbladder was resected. A pedunculated and lobulated protrusion,1.5×0.8×0.5 mm, in the body of the excised gallbladder was minutely studied histologically, and a diagnosis of focal carcinoma in the adenoma was made. Three gallbladder stones were also found,0.3～0.4 cm in diameter, which were not noticed before the operation. There have been a number of reports, including ours, puting special emphasis on the relationship between gallstones and carcinoma of the gallbladder or gallstones and malignant transformation of gallbladder tumors. Chirstensen reported that he noticed three cases of malignant changes from non-papillary adenoma. Our case was of interest to us because it was a focal carcinoma in non-papillary adenoma. At any rate, tumors of the gallbladder accompanied by gallstones, although believed to be benign, should be resected at an early stage. At present, preoperative diagnosis of “early” gallbladder carcinoma is difficult. Detailed re-evaluation of such cases both from the aspects of clinical diagnosis and pathology would lead, as we have more experience, to the first step to overcoming early cancer of the gallbladder.