術前7か月にわたり超音波検査にて経過を観察した早期胆囊癌の1例

Follow-up of an Early Carcinoma of the Gallbladder Using Ultrasonography

要旨　患者は71歳女性で食後の上腹部鈍痛にて来院．USにて胆囊体部に12mm大の丈の低い隆起性病変を認め，表面型の早期胆囊癌が疑われた．しかし，その後しばらく通院がなされず，6か月後のUSでは結節性隆起に増大，その1か月後の術前には18×11mm大となった．摘出胆囊の病理所見では，2か所に幅2cm弱の広基Ⅰ＋Ⅱa型とⅡa型の深達度pmの早期癌が認められ，いずれも高分化型の管状腺癌で，脈管侵襲やリンパ節転移はみられなかった．USでは前者の病変を捉えており，本例は7か月の経過でⅡa型癌が広基Ⅰ型を主体とする癌に進展発育したことが，US画像上示唆された．

　An old house-wife of 71 year-old came to us complaining of vague postprandial pain in the right upper quadrant. She had experienced the pain for one month. Ultrasound examination revealed an elevated lesion on the mucosal surface of the gallbladder wall suggesting early stage of carcinoma (Fig. 1 a, b).

　The patient left us against our advice as she had got relief without any medication and we were unable to follow-up our suspicions. Six months later she came for her long awaited follow-up ultrasound examination. We noticed an obvious enlargement of the lesion and advised operation (Fig. 2, 3).

　The diagnosis was further confirmed by endoscopic ultrasound examination (Fig. 4), and abdominal CT (Fig. 5).

　Extended cholecystectomy was performed after seven months had passed since the original diagnosis was made. Grossly, two foci of carcinoma were seen (Fig. 6). Histopathology revealed well differentiated adenocarcinoma limited to the fibro-muscular layer of the gallbladder wall (Fig. 7). No lymphnode metastasis was found.