早期胆管癌の1例―画像診断の適応と限界

Early Cancer of the Extrahepatic Bile Duct, Report of a Case

要旨　患者は63歳の男性で，発熱と黄疸を契機として発見された．術前のERCPでBiの胆管癌と診断．生検では乳頭腺癌であった．EUSで膵浸潤ありと診断したが，門脈に浸潤なく根治手術可能と考え膵頭十二指腸切除術を施行した．肉眼形態は結節浸潤型，乳頭腺癌，深達度はfmであった．術前に腫瘍の存在診断と質的診断は可能であったが深達度診断を誤診した．早期胆管癌の診断については今後壁の垂直方向の深達度診断が課題と考えられた．

　The patient was a 63-year-old male who suffered from fever and jaundice. ERCP and EUS disclosed an irregular surface nodule in the intrapancreatic common bile duct. The biopsy specimen, obtained via the orifice of the major papilla, showed a papillary adenocarcinoma. Pancreatoduodenectomy was performed.

　Pathologically, this tumor was a papillary adenocarcinoma. At its deepest point, the tumor had infiltrated the fibromuscular layer of the wall of the bile duct.

　It seems that tumor detection and confirmation of malignancy is possible. However, it also seems that precise measurement of the depth of infiltration of the wall of the bile duct is difficult.