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まれなRhabdoid featureを呈した巨大直腸癌を報告する．症例は75歳の男性で，肛門痛，肛門出血を認め，近医を受診した．肛門皮膚に浸潤した腫瘍を認め，直腸癌疑いにて当科入院となった．大腸内視鏡検査にて直腸Rbから肛門皮膚にかけて全周性で約10cmの腫瘍を認めた．腹部CT，MRIにて直腸下部から肛門にかけて巨大腫瘤を認め，仙骨前面に浸潤が疑われ，直腸切断術を施行した．病理組織学的診断では腫瘍細胞は核が偏在し，好酸性の細胞質を有していた．免疫染色ではcytokeratin，vimentinに陽性であり，電子顕微鏡像では細胞質内の渦巻状の中間径フィラメントの集族により核は圧排されていた．以上より，rhabdoid featureを呈した直腸癌と診断した．術後2か月で左鼠径部リンパ節転移を認め，化学療法を開始するも，術後5か月で死亡した．Malignant rhabdoid tumorの多くは幼小児期に発生する予後不良な腎原発腫瘍であり，消化管でrhabdoid cellを認めることはまれである．

空腸gastrointestinal stromal tumor (GIST)に対し手術を施行後3年6カ月で腹膜再発をきたした症例を経験したので報告する.症例は52歳の男性で下血,貧血を主訴に当院を受診した.小腸造影,腹部CT, 腹部血管造影検査にて, Treitz靱帯から20cmの空腸に径7×5×5cm大のhypervascularな腫瘍を認めた.空腸原発の平滑筋肉腫と診断し,平成8年6月17日,空腸部分切除を施行した.病理組織検査では400倍率1視野に核分裂像を2, 3個認め,免疫組織化学検査ではα-smooth muscle actin (SMA), S-100蛋白が陰性, CD34, c-kitが陽性であり, GIST, uncommitted type, malignantと診断した.外来での腹部CTにて上腹部から骨盤に腹膜転移と考えられる腫瘤を認め,平成12年1月12日に開腹術を施行した.腹腔内に無数の腹膜転移を認めたため,試験開腹術に終わる.平成12年12月25日,腹膜播種の増悪にて死亡した.

分節型胆嚢腺筋症に合併した石灰乳胆汁に対し,腹腔鏡下胆嚢摘出術を施行した症例を経験したので報告する.症例は72歳,女性.近医にて肝機能障害を指摘され精査加療目的に当科紹介となった.入院時検査成績では肝胆道系酵素の上昇を認めた.腹部単純X線で右上腹部に立位で鏡面形成を示す石灰化陰影を認め,石灰乳胆汁が疑われた.腹部超音波,腹部CT, 腹部MRIにて胆嚢頸部の分節型胆嚢腺筋症に合併した石灰乳胆汁と診断し,腹腔鏡下胆嚢摘出術を施行した.胆嚢頸部に分節型の胆嚢腺筋症を認め,それより底部側は糊状緑色の石灰乳胆汁が充満していた.病理組織検査にて胆嚢腺筋症と診断された.術後経過は特に問題なく第8病日に退院となった.分節型胆嚢腺筋症に合併する石灰乳胆汁は極めて稀であり,文献的考察を加え報告する.

乳癌の肝転移は他臓器の再発に比べ予後不良で再発乳癌のlimiting factorとして重要視されている.肝転移の切除後4年10カ月無再発生存中の1例を経験したので報告する.症例は63歳,女性.平成6年4月11日,左乳癌T1N0M0 (Stage I)の診断で胸筋温存乳房切除術を施行した.病理組織学的診断はt1n0m0 (stage I), invasive ductal carcinoma, scirrhous, ER (-)であった.以後,外来にて内分泌化学療法を施行し経過観察中,平成9年1月に施行された腹部超音波検査,腹部CT検査にて肝S6/7一部S8に径約4cmの孤立性腫瘍を認めた.その他,肺,骨などに明らかな病変を認めず,肝単独孤立性転移と診断し平成9年2月14日肝右葉切除術を施行した.病理組織検査で乳癌の肝転移と診断した.肝切除術後4年10カ月,再発の徴候を認めず,外来通院中である.

症例は63歳,男性で胸やけ,血便,腹満感を主訴に当科を受診した.精査の結果,横行結腸間膜に発生し,胃,横行結腸,空腸に浸潤した間葉系腫瘍の診断にて手術を行った.手術所見では腫瘍は横行結腸間膜を中心に横行結腸,幽門側胃,空腸を巻き込み一塊となっており,これらを一括に切除した.切除標本では腫瘍は16×12×9cm大で横行結腸の粘膜面に9×8cm大の3型腫瘍を認め,病理組織学的検討ではH-E染色で一部に小腺腔の形成や扁平上皮化生を伴った低分化腺癌と診断されたが,免疫組織染色ではグリメリウス染色,クロモグラニン染色,NSE染色が陽性であり,最終的にneuroendocrine carcinomaと診断された.本症例は術後多発性肝転移をきたし術後3カ月には死亡するという経過をたどった.

患者は24歳の男性. 主訴は右季肋部痛で, 血液検査ではCEAとAFPが高値を示した. 超音波では肝右葉前区域を占める腫瘍を認め, 内部には嚢胞様病変を多数認めた. CTでは径15cmの腫瘍のほとんどが早期より造影されたが, 一部に壊死を疑う造影不良な領域を認めた. 血管造影では, 腫瘍はhypervascularで動静脈瘻の形成を認め, CT門脈相では広範な陰影欠損領域内に取り込まれた門脈枝を認めた. 肝血管肉腫を疑い肝右葉切除術を施行した. 切除標本では充実性の腫瘍内に血液と粘液様物質の貯留した嚢胞があり変性壊死を伴っていた. 組織学的には短紡錘形異型細胞が増殖し, 拡張した胆管や門脈が介在し, 特定の構造分化を示さないが一部に硝子滴が認められ肝未分化肉腫と診断された. 免疫染色では神経や筋および血管系のまーかーは陰性でCD34のみが強陽性であった. 本疾患はまれであり, CT門脈相やCD34免疫染色が新しい診断方法になりうると考えられたので報告する.

5年間に経験した切除不能の大腸癌肝転移22例を対象として, 肝転移に対する肝局所療法の効果および治療成績を, 性別, 腫瘍の原発部位, 肝転移の時期, 転移個数, 腫瘍量, 肝外病変の有無, 肝動脈血管造影下CT (CT-A) における転移巣の動脈血供給量の点から検討した. その結果, 転移巣の動脈血供給量の豊富な群の奏効率は66.7%と動脈血供給量の乏しい群の10.0%に比べ有意に (p=0.007) 高率であった. 治療成績について検討すると, CT-Aにおける動脈血供給量の豊富な群の1年, 2年, 3年生存率は91.7%, 46.3%, 13.9%と動脈血供給量の乏しい群の33.3%, 11.1%, 11.1%に比べ有意に (p

患者は78歳の女性.後腹膜の黄色肉芽腫で左腎摘出術を施行された既往がある.主訴は左下腹部痛で, 同部に一致して径10cmの腫瘤を触知し, 血液検査ではCEA とCA19-9が高値を示した. CTでは左後腹膜に石灰化を有し周囲に脂肪成分を伴う腫瘤を認めた.注腸造影では下行結腸は内側に圧排され, また盲腸に腫瘤陰影を認めた.2型盲腸癌と黄色肉芽腫の再発との診断で手術を施行した.下行結腸周囲の後腹膜腔に複数の腫瘤を認め, 迅速病理にてmyxoid sarcomaと診断されたため結腸左半切除術を施行し, また盲腸癌にて回盲部切除術を併施した.切除標本では漿膜下から後腹膜に黄褐色または灰白色な弾性硬の腫瘤を認めた. 組織学的には分化型の軟骨肉腫や骨肉腫, 平滑筋肉腫および脂肪肉腫の成分を認め悪性間葉腫と診断された.盲腸癌は2型の高分化腺癌でss, ly2, v0, n1 (+) であった. 本疾患はまれであり組織発生を検討する上で興味ある症例と考えられたので報告する

The role of leukotriene (LT) on liver regeneration after hepatectomy is still unknown. LTB4 stagnates in the liver with obstructive jaundice, because LTB4 is excreted in the bile; therefore, LTB4 may have an effect on liver regeneration after hepatectomy with obstructive jaundice. Release of obstructive jaundice and simultaneous 70% hepatectomy was performed in rats to study the effect of 5-lipoxygenase inhibitor (AA-861) on liver regeneration. Group 1 underwent hepatectomy with administration of 0.1 mL dimethyl sulfoxide (DMSO), group 2 underwent hepatectomy with administration of AA-861 (20 mg/kg/d) dissolved in 0.1 mL DMSO, group 3 underwent hepatectomy with administration of AA-861 (40 mg/kg/d) dissolved in 0.1 mL DMSO, group 4 underwent release of obstructive jaundice and hepatectomy with administration of 0.1 mL DMSO, and group 5 underwent relief of obstructive jaundice and hepatectomy with administration of AA-861 (20 mg/kg/d). DMSO or AA-861 was administered 24 hours before, during, and 24 hours after hepatectomy in each group. Whole blood LTB4 and serum alanine aminotransferase (ALT), total bilirubin, and bromodeoxyuridine labeling index (LI) were measured before and after hepatectomy. The LTB4 level increased during obstructive jaundice and after hepatectomy. LTB4 and serum ALT levels were significantly lower after hepatectomy in the rats that were administered AA-861, and a significantly higher LI was observed at 24 hours after hepatectomy in rats receiving AA-861. Inhibition of 5-lipoxygenase promotes liver regeneration and decreases hepatocyte injury after hepatectomy associated with obstructive jaundice.

The pancreatic function diagnostant (PFD test) and fecal chymotrypsin test were performed simultaneously in patients after pancreatic surgery, and findings for both tests were analyzed. The p-aminobenzoic acid recovery rate in the PFD test and the chymotrypsin activity in stools decreased after pancreatectomy, particularly after extended radical pancreaticoduodenectomy. Chymotrypsin activity in stools, measured by the fecal chymotrypsin test after extended radical pancreaticoduodenectomy, was significantly lower than the normal level. The D-xylose output in the extended radical group was significantly (p

The purpose of this study was to evaluate the effectiveness of 15-deoxyspergualin (DSG) administration against acute rejection of canine pancreatic allografts. Subsequent to partial pancreatic allotransplantation and total extirpation of the pancreas, 20 adult mongrel dogs were divided into four groups and treated with saline (group 1, controls, n = 5), DSG at 1.0 mg/kg/day (group 2, n = 5), DSG at 3.0 mg/kg/day (group 3, n = 5), or DSG at 5.0 mg/kg/day (group 4, n = 5) on postoperative days 4-7. The graft survival, defined by a fasting serum glucose level < 150 mg/dl, was significantly prolonged from 6.2 +/- 1.2 days in group 1 to 12.4 +/- 2.7 days in group 3 (p < 0.05) and to 16.8 +/- 3.2 days in group 4 (p < 0.05). Graft survival was not significantly prolonged in group 2, however. Two normoglycemic dogs in group 4 died due to gastrointestinal toxicity, one of the most serious side effects of DSG. The observation that the serum insulin levels increased in dogs treated with DSG was compatible with dose-dependent graft survival and suggested that DSG had no toxic effects on pancreatic endocrine function. In group 1 significantly increased thromboxane B2 (TXB2) levels and TXB2/6-keto-prostaglandin F1 alpha (PGF1 alpha) ratios were observed on postoperative days 3-5 which was thought to reflect acute rejection. Following administration of DSG, both TXB2 levels and TXB2/PGF1 alpha ratios were decreased on the 5th postoperative day in groups 2-4.(ABSTRACT TRUNCATED AT 250 WORDS)

This study was performed to examine the immunosuppressive effect of a 5-lipoxygenase inhibitor, AA-861, on liver transplantation in rodents, and also to examine the production of eicosanoids during rejection of liver allograft in these animals. Rats were divided into three groups: group I (syngenic orthotopic liver transplantation from LEW to LEW), group II (allogenic OLT from ACI to LEW with dimethyl sulfoxide), and group III (allogenic OLT from ACI to LEW with AA-861 [20 mg/kg/day] s.c. dissolved in DMSO). Histological examinations were performed, survival time was monitored, and eicosanoid levels at 3, 5, and 7 days after transplantation were measured. Mean survival time in group III was significantly longer than that in group II (36.0 +/- 6.8 vs. 11.1 +/- 0.7 days, mean +/- SEM; P < 0.01). Histologically, the degree of rejection in group III was moderate compared with that in group II. On day 3, the LTB4 level in group II was significantly higher than that in group I (3361 +/- 985 vs. 407 +/- 70 pg/ml, P < 0.05), and the PGE2 level in group III was significantly higher than that in group 1 (50.3 +/- 4.8 vs. 23.5 +/- 4.7 pg/ml, P < 0.01) and in group II (32.9 +/- 4.2 pg/ml, P < 0.05). These findings suggest that AA-861 reduced liver allograft rejection by suppressing the elevation of 5-lipoxygenase products and increasing PGE2 production in the early stage of rejection.

症例は64歳の男性で, 昭和56年8月に胸部中下部食道癌 (A0N0M0Pl0, Stage I) にて右開胸開腹胸腹部食道全摘術および胸骨後経路頸部食道形成胃管吻合術を受けた.切除標本の病理組織診断は低分化型扁平上皮癌, 深達度ep, n (-) であった.術後10年目に嘔気と嘔吐を認めたため内視鏡検査を施行したところ, 門歯列より26cmの再建胃管内に径2.0cmの山田III型ポリープを認めた.生検結果は中分化型腺癌であった.超音波内視鏡検査で深達度mと診断されたため, 内視鏡的ポリペクトミーを施行した.切除ポリープは病理組織学的に乳頭状腺癌, 深達度mで断端における癌の浸潤も認めなかったため治癒切除と判断された.食道早期癌術後の再建胃管に発生した早期胃癌の本邦報告例は, これまでに自験例を含め3例のみときわめてまれであったが, 再建胃管癌46例の本邦報告例の検討からは, 早期発見のため術後の再建胃管の定期的な検索が必要であると思われた.

The clinicopathological features of hepatocellular carcinoma (HCC) arising in the noncirrhotic liver were studied in 26 patients against a background of 97 patients with HCC associated with cirrhosis. In the majority of noncirrhotic cases, ono or more hehatic lobes were resected because of the large tumor. As regards vascular invasion, in the cirrhotic cases, the frequency of portal vein invasion was high but the incidence of hepatic vein invasion was low at any site of tumor size. On the other hand, in the noncirrhotic cases, the frequency of portal vein invasion was low as same as the hepatic vein invasion at the small tumors, but as the tumor became larger, both frequency became higher. The prognosis of HCC without cirrhosis was better than those with cirrhosis, and then we can perform more useful treatment for patients with HCC without cirrhosis if the tumor can be diagnosed at an early stage.

The plasma glucose and amino acid levels of a patient who had undergone total gastrectomy and total pancreatectomy 15 years previously were examined under 4 conditions determined by the method of exogenous glucagon injection. Glucagon was not injected in the first period, and 1mg of glucagon was injected twice a day in the second period. Twice a day 1mg of zinc glucagon was injected in the third period, and 2mg/day of glucagon by continuous subcutaneous glucagon infusion (CSGI) was given in the fourth period. The plasma pancreatic glucagon levels were within the normal range during CSGI. The effect of glucagon on plasma amino acid levels was greatest with CSGI. The effect became less in the order of zinc glucagon injection and twice-a-day injection of 1mg of glucagon. Furthermore, afternoon hyperglycemia and nocturnal hypoglycemia were suppressed with CSGI. Urinary nitrogen excretion was increased with glucagon injection. However, excretion of 3-methylhistidine did not show any significant increase. From these results we consider that exogenous glucagon injection has significant effects on the metabolism of glucose and amino acids after total pancreatectomy. We also conclude that both continuous subcutaneous glucagon infusion and zinc glucagon are useful in the postoperative management of total pancreatectomy.

From January 1978 to December 1989, 48 patients were diagnosed as having anomalous union of the pancreaticobiliary ductal system (AUPBD) at the Second Department of Surgery, Kanazawa University Hospital and its affiliated hospitals. Among these 48 patients, 13 (28.1%) were children under 13 years of age. Four of these patients had acute pancreatitis. The clinical, radiological, and surgical features of these patients are presented. The chief presenting complaint was epigastric pain in all cases; three patients had recurrent episodes of epigastric pain and had been diagnosed as having autotoxicosis. AUPBD was clearly demonstrated in all patients, three by endoscopic retrograde cholangiopancreatography (ERCP) and one by operative cholangiography. At operation, macroscopic evidence of pancreatitis was recognized in all cases. In one case, roentogenolucent pancreaticolithiases were seen on ERCP. We consider AUPBD as an important cause of pancreatitis in children and advocate ERCP in children who are suspected having biliary tract or pancreatic disease. The diagnosis of AUPBD should be considered when children with abdominal pain and elevated serum or urinary amylase levels are evaluated.

A 58-year-old man on abdominal ultrasonography and CT had an irregularly elevated lesion at the neck of the gallbladder and a cyst of approximately 6.5 cm in diameter at the pancreatic tail. Percutaneous transhepatic cholangiography revealed a 2-cm shadow defect at the neck of the gallbladder and an irregular, translucent 30 x 12 mm lesion in the intrapancreatic bile duct. Total pancreatectomy and extended cholecystectomy with regional lymph node dissection was performed. An anomalous arrangement of the pancreaticobiliary ductal system (AAPBD) was demonstrated by postoperative contrast radiography of resected specimen. The lesions of the gallbladder and common bile duct were papillary adenocarcinoma. In addition, papillary adenocarcinoma was limited almost entirely to the mucosal layer of the main pancreatic duct and its branches, from the junction of the common bile duct and pancreatic duct to the pancreatic tail. The three tumors were not continuous. The cyst at the pancreatic tail was a pseudocyst. This case represents synchronous cancer of the gallbladder, common bile duct, and pancreas associated with AAPBD.

An increasing number of patients with lung cancer are undergoing outpatient chemotherapy as an alternative to inpatient therapy. To investigate the factors influencing the quality of life (QOL) for these patients, we administered a QOL questionnaire, The QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs (QOL-ACD) to 8 older adult patients with non-small cell lung cancer. The medical factors related to the overall QOL scores and other categories indicating activity, physical condition, psychological condition, social relationship, psychological condition and face scale were analyzed. No significant decrease in each factor was observed in this study.

Ramsay Hunt症候群は,顔面神経麻痺,内耳神経症状,外耳道,耳介周辺部の疱疹を三兆候としているが,帯状疱疹と顔面神経麻痺出現の時期についての詳細な報告は見当たらない.我々は,ウイルス性髄膜炎を併発した,三叉神経第2枝帯状疱疹例に対し,早期より抗ウイルス剤の投与および神経ブロック療法を施行し,順調に経過していたにもかかわらず,発症3週間後に遅発性顔面神経麻痺を生じた症例を経験した.顔面神経麻痺出現時には,すでに皮疹および疼痛はほぼ消失しており,VZV感染と顔面神経麻痺の因果関係は明確にできなかった.また,従来は,Ramsay Hunt症候群の治療として抗ウイルス剤の投与や星状神経節ブロックが施行されているが,今回の症例では,顔面神経麻痺出現前より,これらの治療を行なっていたが,その出現を防止できなかった.

Thirty-nine cases of hepatocarcinoma in stage IV were divided into 17 of resected (noncurative resection; group 1) and 22 of nonresected cases (group 2), and studied for the correlations between the prognosis and treatments. Group 1 patients underwent tumor reduction surgery, followed by transcatheter arterial embolization (TAE) and hepatic arterial infusion (HAI) as well as perioperative ethanol injection (EI) for the remnant carcinoma. Group 2 patients who didn't undergo tumor reduction received intensive treatment such as TAE, HAI, EI, hyperthermia and irradiation.Results: 1) In cases of Vp0 and 1, the prognosis of group I was better than that of group II (p

A 77-year-old man was admitted to our hospital complaining of general malaise, loss of appetite and hemoptysis. Chest X-ray film and computed tomography (CT) scan showed right-sided pleural effusion with lung tumor. Succeeding upper gastro-intestinal fiberscopy and cystoscopy revealed poorly-differentiated adenocarcinoma of the stomach and urothelial carcinoma of the bladder. Repeated treatment with 100 mg/body of S-1 on day 1 followed by 60 mg/m(2) of cisplatin on day 8 was effective in this patient.

Between 1978 and 1988, 15 patients with gallbladder cancer and 2 patients with bile duct cancer were seen among 49 patients with anomalous union of the pancreaticobiliary ductal system. Radiographic findings revealed two types of this anomalous condition: one in which the pancreatic duct entered the common bile duct (type 1) and one in which the common bile duct entered the pancreatic duct (type 2). In gallbladder cancer, the common bile duct presented no dilatation, or in some patients, mild dilatation, and type-1 anomalous union was frequently found among these patients. In contrast, the two patients with bile duct cancer had cystic dilatation of the common bile duct and type-2 anomalous union. The bile amylase level, which was determined in seven patients, was extremely high in all the patients. Histopathologically, the tumors in most patients showed papillary to papillo-tubular proliferation in the mucosal layer while atypical epithelial hyperplasia was noted in the vicinity of the tumor area. These findings suggest that this congenital anomaly in both ducts results in a loss of the normal sphincteric mechanism of the duodenal papilla, and that chronic relapsing cholecystitis or cholangitis, caused by the reflux of pancreatic juice into the biliary tract, can induced progressive changes to atypical epithelial hyperplasia which may develop into carcinoma.

An increasing number of patients with lung cancer are undergoing outpatient chemotherapy as an alternative inpatient therapy. To investigate the factors influencing the quality of life (QOL) for these patients,we used a QOL questionnaire, "The QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs" (QOL-ACD) for 8 patients with non-small cell lung cancer. The medical factors related to the overall QOL scores and other categories indicating "activity," "physical condition," "psychological condition," "social relationship" and "face scale" were analyzed. Significant improvements in the factors indicating "psychological condition" were observed in this study.

We experienced a case of cesarean section in a patient with a fetus having a prenatally diagnosed huge cervical mass, which could cause airway obstruction immediately after delivery. The fetal cervical mass was confirmed at 19 gestational weeks, and amniocentesis was performed at 33 weeks. At 35 weeks, MRI showed the large mass that could disturb the airway patency after birth, and elective cesarean section was scheduled at 37 weeks. In the anesthetic management, anesthesia was maintained with isoflurane in oxygen, and ritodorine and nitroglycerin were used for obtaining uterine relaxation and keeping uteroplacental circulation. Fetal head was exposed from the uterine incision site and tracheal intubation was successfully performed. After confirming the neonatal oxygenation under manual ventilation, the baby was delivered. After delivery, the mass was diagnosed as cystic hygroma and he was maintained under mechanical ventilation in NICU. Five months later subtotal excision of the cervical cystic hygroma and tracheostomy were performed.

Gastroesophageal reflux is associated with a high incidence of complications such as ulcer or cancer of the esophagus [1]. Gastrectomy results in regurgitation of bile into the esophagus. However, the etiologic role of gastrectomy in esophageal cancer is still controversial [2]. Surgical treatment of postgastrectomy esophageal cancer is also investigational, because esophageal reconstruction with vascularized graft in the patient who has undergone gastrectomy is sometimes difficult due to the presence of adhesion. In this connection, we reviewed 14 cases of postgastrectomy esophageal cancer among our series.

Between 1978 and 1989, 13 of 48 patients with anomalous union of the pancreaticobiliary ductal system (AUPBD) were diagnosed as having acute pancreatitis. We have studied the clinical, radiologic, and surgical features of these 13 patients. A transient rise in the intraductal pressure of the pancreatic duct during an episode of abdominal pain is responsible for pancreatitis in patients with AUPBD. This rise in the intraductal pressure must be due to bile reflux into the pancreatic duct when an abnormally long common channel is blocked by cholelithiasis, protein plug, or dysfunction of the sphincter of Oddi. The pancreatitis resolves when the common channel obstruction is removed, and bile and pancreatic juice flow easily into the duodenum. We believe that this phenomenon is responsible for acute relapsing pancreatitis. It is our belief that the pancreas appears almost normal during symptom-free intervals.

A prospective evaluation of the accuracy of real-time ultrasonography (US), computed tomography (CT), infusion hepatic angiography (IHA), and computed tomography during arterial portography (CT-AP) was performed on 65 resected liver metastases of colorectal cancers. The total detection rate was 58.5 percent for US, 56.3 percent for CT, 55.4 percent for IHA, and 86.2 percent for CT-AP. The sensitivity of 29 lesions with diameters of smaller than 1 cm was 65.5 percent for CT-AP, CT found only two, and both US and IHA localized no more than three. The smallest lesions detectable by CT-AP were as small as 0.4 cm in diameter. CT-AP proved most useful in detecting the liver metastases, and the use of this technique is recommended for preoperative planning of hepatectomy on patients with liver metastases.

本邦では極めてまれな,女性ホルモン剤による肝の腫瘍類似病変の1例を報告した.症例は64歳,男性.54歳時に前立腺癌で前立腺および睾丸除去術を受け,内分泌療法として合成女性ホルモン剤のdiethylstilbestrol phosphateを300mg/day,術後10年間にわたって内服していた.食欲不振を主訴に来院し,精査の結果腹部超音波でS8に径2cmのhypo echoic lesionを認め,血管造影でも同部位の濃染像を認めたため,肝細胞癌を強く疑い,S8部分切除術を施行した.切除標本は径15mmの黄色の結節で,組織学的には肝細胞の過形成性病変であり,周囲肝実質を圧排する様に増生していたが,被膜はみられなかった.同部の小葉構築は乱れ,中心静脈の増生を認めたが,核には異型性は認めなかった.FNHなどの既存の疾患の範疇には属さず,肝細胞過形成病変と診断した.

A 58-year-old man was found to have an irregular, elevated lesion in the neck of the gallbladder and a cyst of about 6.5 cm in diameter in the tail of the pancreas by abdominal ultrasonography and CT. Percutaneous transhepatic cholangiography revealed about 2 cm shadow defect at the neck of the gallbladder and a translucent image of 30×12 mm in the intrapancreatic bile duct. A bile test and smear examination revealed both gallbladder bile and the bile duct tumor to be class V. Based on the above findings, the patient underwent surgery under the diagnosis of carcinomas of the gallbladder and common bile duct, and chronic pancreatitis accompanied by pancreatic cyst. Total pancreatetomy and extended cholecystectomy with R2 lymph node dissection were performed because a suspected tumorous lesion was found within the pancreatic cyst by intraoperative ultrasonography. The lesions in the gallbladder and common bile duct were stage I papillary adenocarcinoma with a depth of invasion to ss and stage I papillary adenocarcinoma with a depth of invasion to m. In addition, a papillary adenocarcinoma was localized almost entirely in the main pancreatic duct and its branch, ranging from the head to the tail of the pancreas. The cyst in the pancreatic tail was a pseudocyst. No continuity was noted between the tumors. Furthermore, anomalous arrangement of the pancreaticobiliary ductal system was evidenced by postoperative contrast radiography of surgical specimen.

肝未分化癌の1例を報告した.本例は,画像診断上嚢胞性変化を伴うhypovascular瘍として描出されたが,術前の質的診断は困難で,切除標本の病理学的検索にて診断が確定した.臨床的には,自覚症状を欠き,血清CEA値の軽度上昇を認めたが,AFPは陰性で,肝機能検査にも異常は認められなかった.肝左葉外側区域切除術にて完治し,4年後の現在,再発の徴候なく元気に生活している.切除標本では,腫瘍の境界は明瞭で,病理学的に,凝血塊を満たす拡張した血管腔と充実性の腫瘍塊より成り,被膜形成はなく,一部周囲肝実質へ浸潤していた.組織学的には,小型円形の未分化な腫瘍細胞が充実性に発育し,毛細血管から成る間質を認めた.腫瘍細胞の胞体は好酸性で,核は中等度のクロマチンを認め,円形乃至不整円形であった.核小体は小さく,mitosisはわずかに認められるのみであった.