横隔膜上リンパ節転移で再発し胸腔鏡下に切除した胆管細胞癌の1例

Thoracoscopic resection of supra-diaphragma lymph node recurrence of cholangiocellular carcinoma : A case report

◆要旨：患者は74歳，男性．既往歴にC型慢性肝炎，膵管内乳頭粘液性膵癌．2004年10月，CT検査で肝臓S8に増大する腫瘤を認め，2005年8月，肝S8亜区域切除術を施行した．腫瘍は胆管細胞癌（CCC）で，近傍に小さな肝細胞癌（HCC）が併存する混合型肝癌であった．2007年2月，CT上で増大する腫瘤を右横隔膜上に認めた．同年3月，positron emission tomography（PET）で同腫瘤のSUVmaxは4.3と上昇した．胆管細胞癌再発を疑い，4月に胸腔鏡補助下右横隔膜上腫瘍切除術を施行した．病理組織検査で胆管細胞癌のリンパ節転移と診断された．術後7日目に退院し，現在再発なく外来通院中である．

　In 2005, a 74-year-old Japanese man was diagnosed as having liver tumors in the anterior superior segment by computed tomography（CT）. His past medical history was chronic hepatitis C and intraductal papillary-mucinous neoplasm（IPMN）. Angiography, CTduring arteriography（CT-A）and CTduring arterial portography（CT-AP）showed a hypervascular tumor which was enlarging gradually and another small tumor. Subsegmental hepatectomy was performed in August, 2005. The main tumor was diagnosed as cholangiocellular carcinoma（CCC）, and the satellite tumor as hepatocellular carcinoma（HCC）by immunopathological diagnosis. At 6 months after hepatectomy, enhanced CT showed a mass lesion in the ventral area of the remnant liver. In February 2007, CT showed that this lesion was enlarging and located above the diaphragm. Positron emission tomography（PET）scan showed the lesion was taking in fluorodeoxyglucose（FDG）, of which SUVmax was 4.3. In April, thoracoscopic tumorectomy was performed. Pathological examination revealed a lymph node metastasis of CCC. A patient is alive 12 months without recurrence.