USおよびERCPにて術前に診断しえた早期胆囊癌の1例

Early Carcinoma of the Gallbladder, Report of a Cace

　早期胆囊癌に関するまとまった報告はまだ少なく，その定義も確定していない．これは，胆囊癌それ自体のみでは早期であればあるほど著明な自他覚症状を発症し難く，また胆囊壁に粘膜筋板を欠くために比較的早い時期に血行性，リンパ管性転移を来しやすく，早期発見の機会が少ないことが最大の理由と考えられる．したがって，胆囊癌は早期診断・早期治療の困難な臓器とされておりこれまでの報告にても胆石や胆囊炎との術前診断で胆摘術が施行され，組織学的検索により早期胆囊癌と診断された例がほとんどである．今回，われわれは胆囊超音波断層撮影法およびERCPにて術前に胆囊Ⅱa様癌および胆囊ポリープを疑い手術により胆囊粘膜内癌および乳頭状腺腫内の癌化を確認した症例を経験したので報告する．

　A 41-year-old woman complaining of right hypochondralgia and low grade fever of about one week's duration, was admitted to our hospital on March 12, 1981.

　Peroral cholecystograms showed abnormal gallbladder in its shape and contraction except for a mild irregularity of the wall at the neck. In abdominal ultrasonography (US) two small polypoid lesions without acoustic shadow or movement were noted at the neck of the gallbladder, where the wall was partially thickened. ERCP pictures also demonstrated two small polypoid lesions 6×3 mm in size and a Ⅱa-like, irregular, low elevated lesion 25×12 mm in size at the same portion of the gallbladder. No other abnormalities were found in the liver, biliary tract and pancreas.

　As these findings obtained by US and ERCP suggested an early cancer of the gallbladder with polypoid development, laparotomy was done. At laparotomy, no evidence of malignant invasion and metastasis was macroscopically found at the liver, biliary tract, pancreas, regional lymph nodes and other neighboring organs, as well as at the serosa of the gallbladder. Therefore, simple colecystectomy was done.

　On the histological examination the polyps were diagnosed as papillary adenomas with focal adenocarcinoma, and the Ⅱa-like elevated lesion was diagnosed as a well differentiated adenocarcinoma limited to the mucosa.