Early Gallbladder Carcinoma Which Combined Elevated Type (Type Ⅰ and Ⅱa) with Broad Flat Type (Type Ⅱb) Lesions, Report of a Case:Including the utility and the limit of endoscopic ultrasonography in its diagnosis Takayoshi Noguchi 1 , Tsuyoshi Aibe 1 , Tadayoshi Takemoto 1 , Susumu Kawamura 2 1The First Department of Internal Medicine, Yamaguchi University, School of Medicine 2Internal Medicine, Yamaguchi Rosai Hospital pp.585-589
Published Date 1987/5/25
DOI https://doi.org/10.11477/mf.1403112864
  • Abstract
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 The patient had no symptoms but visited the clinic of our hospital, wishing to undergo further examination of the liver. There were no abnormalities in the blood chemistry, and no morphological changes of the liver were revealed by conventional ultrasonography (US). However, an elevated lesion was detected in the gallbladder by US, and a gallbladder carcinoma was suspected.

 The same elevated lesion accompanied with a small polypoid lesion was demonstrated by ERCP, but definite diagnosis of gallbladder carcinoma could not be made by ERCP. In enhanced CT, the main lesion was visualized as a high density area and a carcinoma was strongly suspected.

 In contrast to findings by these diagnostic procedures, not only the main lesion but some small polypoid lesions could be demonstrated very clearly by endoscopic ultrasonography (EUS). And, on the basis of the difference of the internal echo pattern of these lesions, gallbladder carcinoma was able to be diagnosed by EUS. Furthermore, the depth of the invasion of these lesions was able to be diagnosed as limited to the mucosa. This was possible because the layer structure of the gallbladder wall, which was visualized by EUS, was intact at the places where these lesions were discovered.

 A large elevated lesion (type Ⅰ) with some small polypoid lesions (type Ⅱa) was seen in the resected gallbladder after operation. Pathological examination confirmed our suspicion that all of these lesions were carcinoma with invasion only of the mucosa. However, at the same time, the broad flat cancerous lesions (type Ⅱb) with mucosal invation were pointed out around these elevated lesions.

 In conclusion,EUS was highly evaluated as the best diagnostic procedure to detect the elevated type early gallbladder carcinoma, but it is thought to be incapable of diagnosing the flat type early carcinoma in the gallbladder.

Copyright © 1987, Igaku-Shoin Ltd. All rights reserved.


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