论文信息 - A CASE OF EARLY BILE DUCT CANCER WITH PANCREATICOBILIARY MALJUNCTION IN A 28-YEAR-OLD MALE

A CASE OF EARLY BILE DUCT CANCER WITH PANCREATICOBILIARY MALJUNCTION IN A 28-YEAR-OLD MALE

若年者の早期胆管癌を合併した先天性総胆管拡張症合併膵・胆管合流異常症を経験した. 症例は28歳, 男性. 心窩部痛を主訴に受診した. 急性胆管炎・膵炎を認め, 精査を行った. 膵・胆管合流異常と総胆管の膵上縁より肝門にかけての嚢胞状拡張を認め, 下部胆管の一部に壁不整像が認められた. 戸谷分類Ia型先天性総胆管拡張症を伴った新古味分類IIIc型膵・胆管合流異常症と診断し, 肝外胆管切除・胆嚢摘出・胆管空腸吻合術を施行した. 切除標本の胆管粘膜は粗造でびらんが散在していた. 胆管壁に化生性変化・過形成性変化がみられ, 一部の上皮には異型性も伴っていた. こうした粘膜病変を背景に下部胆管に2mm大の上皮内癌を認めた. 免疫組織染色上, 腫瘍部・異型上皮部でのP53発現が認められた. 胆嚢粘膜にも過形成性変化を認めたが, 悪性所見はなかった. 術後2年6カ月経過した現在, 再発を認めず良好に経過している.

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