需要与肝外胆管癌鉴别的胆管周围腺体增生:病例报告。

IF 0.5 Q4 GASTROENTEROLOGY & HEPATOLOGY Case Reports in Gastroenterology Pub Date : 2024-05-23 eCollection Date: 2024-01-01 DOI:10.1159/000538491
Kazuhiro Takami, Kuniharu Yamamoto, Hiroto Sakurai, Yoshihiro Sato, Noriko Kondo, Toru Nakano, Shingo Tsujinaka, Akinobu Koiwai, Morihisa Hirota, Keigo Murakami, Kazuhiro Murakami, Chikashi Shibata, Yu Katayose
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引用次数: 0

摘要

导言:胆管周围腺体是胆管的附属腺体。这些组织的增生可能导致胆管粘膜隆起和胆管狭窄。我们在此报告一例胆管周围腺增生病例,该病例需要在术前与胆管癌进行鉴别,并对文献进行了讨论:患者升结肠有一处腺瘤性病变,难以通过内镜治疗,因此计划进行手术。术前腹部超声波检查发现了胆管肿瘤,内镜超声波检查发现了胆囊管汇合处的肿块病变。计算机断层扫描显示中胆管局部管壁增厚,上游胆管轻度扩张。此外,还观察到从胆囊到胆囊管汇合处的胆管壁持续增厚。未发现远处转移(如肝转移)或附近淋巴结肿大。内镜逆行胰胆管造影和磁共振胰胆管造影显示,胆囊管汇合处附近的胆管内有乳头状隆起病变,同一部位的活检和胆汁细胞学检查未发现恶性病变。因此,不能排除患者患有胆囊癌或胆管癌的可能性,所以在征得患者充分知情同意后,决定对其进行升结肠肿瘤一并手术治疗。手术期间,患者接受了肝外胆管切除术,采用 Roux-en-Y 方法重建胆道,并进行了右半结肠切除术。手术期间对十二指肠和肝门胆管横断面进行了快速冰冻切片分析,结果显示癌症阴性。切除标本的组织病理学检查显示胆管病变无恶性发现,诊断为胆管周围腺体增生伴慢性炎症细胞浸润和肝外胆管壁纤维化:结论:我们遇到了一例胆管周围腺体增生症与胆管癌难以区分的病例。
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Peribiliary Gland Hyperplasia That Required Differentiation from Extrahepatic Bile Duct Cancer: A Case Report.

Introduction: The peribiliary gland is an accessory bile duct gland. Hyperplasia of these tissues may lead to elevation of the mucosa in the bile ducts and bile duct stenosis. We herein report a case of peribiliary gland hyperplasia that required preoperative differentiation from bile duct cancer, with a discussion of the literature.

Case presentation: The patient had an adenomatous lesion in the ascending colon that was difficult to treat endoscopically; therefore, surgery was planned. Preoperative abdominal ultrasonography revealed a bile duct tumor, and endoscopic ultrasonography revealed a mass lesion around the confluence of the cystic duct. Computed tomography revealed localized wall thickening in the middle bile duct, and the upstream bile ducts were slightly dilated. In addition, continuous thickening of the bile duct wall from the gallbladder to the confluence of the cystic duct was observed. No distant metastases, such as liver metastases, or nearby enlarged lymph nodes were observed. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography revealed a papillary-like elevated lesion in the bile duct near the confluence of the cystic duct, and a biopsy and bile cytology from the same area showed no malignant findings. As a result, the possibility that the patient had gallbladder or bile duct cancer could not be ruled out; therefore, a policy of surgery together with the ascending colon tumor was decided after receiving sufficient informed consent. During surgery, the patient underwent extrahepatic bile duct resection, reconstruction of the biliary tract using the Roux-en-Y method, and right hemicolectomy. Both duodenal and hilar bile duct transects were subjected to a fast frozen section analysis during surgery, and the results were negative for cancer. A histopathological examination of the resected specimen revealed no malignant findings in the bile duct lesions, and a diagnosis of peribiliary gland hyperplasia with chronic inflammatory cell infiltration and fibrosis of the extrahepatic bile duct wall was made.

Conclusions: We encountered a case of peribiliary gland hyperplasia that was difficult to distinguish from bile duct cancer.

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来源期刊
Case Reports in Gastroenterology
Case Reports in Gastroenterology Medicine-Gastroenterology
CiteScore
1.10
自引率
0.00%
发文量
99
审稿时长
7 weeks
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