診断に苦慮した肝内胆管原発腺扁平上皮癌の1例

A case of adenosquamous carcinoma arising from intrahepatic cholangiocarcinoma with diagnostic challenges

今回我々は，右季肋部痛の精査で右副腎から肝右葉にまたがる約4cm大の腫瘤を認め，副腎癌の肝浸潤疑いでCTガイド下生検を施行して腺扁平上皮癌と診断され，化学放射線療法後に腫瘍切除術を施行した高齢女性の症例を経験した。術後病理診断は胆管浸潤型肝内胆管癌で，腺癌のみで扁平上皮成分の残存は認められなかった。肝内胆管原発腺扁平上皮癌は肝内胆管癌の約3％とまれな組織型で，本症例では副腎癌との鑑別に苦慮したため文献的考察をふまえて報告する。

We report a case of adenosquamous carcinoma arising from the intrahepatic bile duct. A woman in her 70s presented with right flank pain. CT and MRI revealed a tumor involving the right adrenal gland and liver, which was initially suspected to be adrenocortical carcinoma. A subsequent CT-guided needle biopsy identified the tumor as adenosquamous carcinoma of unknown primary origin. Chemoradiation therapy was performed, followed by surgical resection. Postoperative pathological examination confirmed that the primary lesion was a periductal infiltrating-type intrahepatic cholangiocarcinoma.