腹腔鏡下に摘出した肝門部Castleman病の1例

Castleman disease in the hilum of the liver removed by laparoscopic operation : a case report

◆要旨：Castleman病はリンパ節の巨大な腫瘤性病変を特徴とする原因不明の疾患であり，肝門部発生例は非常に稀である．今回，肝門部に発生した若年者Castleman病を腹腔鏡下手術にて摘出した1例を経験したので報告する． 　患者は20歳，女性．右上腹部痛を主訴に近医を受診した．CTにて肝門部周囲に30mm大の腫瘤性病変を指摘され，当科に紹介となった．腹部CT検査およびMRI検査では境界明瞭な病変を認め，腫瘤は均一に造影された．FDG-PET検査では病変部に高度の集積を認めた．画像所見から悪性リンパ腫を疑い，診断を兼ね腹腔鏡下に摘出術を行った．腫瘍は，肝十二指腸間膜に存在し，径30mm大の孤立性，弾性軟であった．病理組織検査にてCastleman病（plasma cell type）と診断された．現在，術後1.5年であるが再発もなく経過良好である．

　A case of Castleman disease at the hepatic hilum is reported. A 20-year-old female presented with right upper abdominal pain. A mass measuring 30mm in diameter was pointed out in the hilum of the liver. Blood examination showed elevation of CRP （3.25mg/ml） and mild anemia （9.7g/dl）. The tumor was homogenously enhanced in the computed tomography, and magnetic resonance imaging showed low intensity in T1 and high-intensity in T2. Positron emission tomography showed an accumulation of 18F-fluorodeoxyglucose based on the mass demonstrated by CT and its standardized uptake value was 10.4. The tumor was excised by laparoscopic surgery, with a suspected diagnosis of malignant lymphoma based on the image studies. An isolated, elastic soft tumor measuring 30×30×20mm was identified in the hepato-duodenal ligament. The resected tumor was a solid mass with whitish-yellow cut surface. Histological examination revealed characteristics of the plasma cell type of Castleman disease. The postoperative course was uneventful, with no recurrence of the tumor 1.5 years after the operations.