胆囊腺腫内m癌の1例

Carcinoma in Adenoma of the Gallbladder, Report of a Case

要旨　患者は56歳女性で，右季肋部痛を主訴とし超音波検査にて胆囊内に径10mmの小隆起性病変を指摘され，経静脈的胆道造影でも胆囊頸部に小隆起性病変が指摘された．入院時検査では異常は認められず，直接胆道造影にて有茎性小隆起性病変で腺腫あるいは腺腫内癌を疑い胆囊摘出術を行った．切除標本肉眼所見ではポリープは太さ2mmの細い茎部と10×6mmの腫大した頭部とから形成されていた．病理組織学的には癌病変は有茎性隆起の頭部内の2×1mmのみに局在し，茎部や周囲粘膜に進展のない深達度mの腺腫内癌であった．細い茎の隆起型胆囊癌は大きさと関係なく深達度mの腺腫内癌のみであり，このことは本例においても確認された．

　A 56 year-old woman visited the hospital with right hypochondralgia as her chief complaint. By ultrasonography, she was found to have an elevated lesion, 10 mm in size, in the gallbladder. DIC also demonstrated a small elevated lesion in the neck of the gallbladder. On admission, laboratory data were within normal limits and direct cholangiography demonstrated a pedunculated polyp suggesting adenoma or carcinoma in adenoma.

　Cholecystectomy was performed and the surgical specimen revealed a polyp to consist of a thin stalk, 2 mm in diameter, and a head, 10×6 mm in size. Microscopically the cancerous portion, 2×1 mm in size, was located within metaplastic adenoma. Cancer tissue was confined within the mucosa without extending to the stalk or adjacent mucosa.

　Considering the previously reported cases together with the present case, it is confirmed that cancer in adnoma forming a pedunculated polyp with thin stalk is always located within the mucosa regardless of the size of the polyp.