胆囊胃瘻に併存した胆囊癌の1例

Carcinoma of the Gallbladder Associated with Spontaneous Cholecysto-gastric Fistula, Report of a Case

要旨　特発性内胆汁棲のうち，胆囊胃瘻はまれである．われわれは，陳旧性の胆囊胃瘻に比較的早い時期の胆囊癌が併存していた興味ある1例を経験した．患者は72歳，男性．健康診断の胃X線検査で異常を指摘され，精査の結果，胆囊胃瘻と診断された．胆囊底部と胃前庭部前壁が強固に癒着しており瘻孔を形成していた．胆囊摘出および胆囊胃瘻部の胃部分切除が施行された．病理組織学的検索で胃粘膜に接して胆囊胃瘻胆囊側に肉眼診断が困難な平坦な胆囊癌が認められた．胆囊癌は1か所で筋層をわずかに越えていた．既往歴より胆囊胃瘻は約30年前に発生したと考えられ，組織学的にも陳旧性のものであった．胆囊癌の発生を考えるうえで貴重な症例である．

　Spontaneous cholecysto-gastric fistula is rare among the enterobiliary fistulas. We encountered a case of carcinoma of the gallbladder associated with an old spontaneous cholecysto-gastric fistula. The patient was a 72-year-old Japanese man who had had a history of severe epigastric pain about 30 years previously. This suggests that the cholecysto-gastric fistula occurred at that time. Cholecystectomy with partial resection of the stomach around the fistula was performed. Macroscopically, the mucosal surface of the fundus of the resected gallbladder was irregular and granular. Histologically, carcinoma of the gallbladder was revealed at the fundus, adjacent to the gastric mucosa at the cholecysto-gastric fistula. The carcinoma had penetrated the muscle bundle at only one portion, and the serosa of the gallbladder was intact. The past history and fibrosis without inflammatory cell infiltration at the fistula indicate that the carcinoma occurred in the gallbladder with the cholecysto-gastric fistula. Microscopically, the gastric mucosa of the resected specimen showed no remarkable change. This is a very important case in regard to carcinogenesis of the gallbladder.