内容紹介
A Long-Term Survival Case of Unresectable Hilar Bile Duct Cancer Treated with Gemcitabine
Summary
A 69-year-old woman was diagnosed with liver dysfunction on blood testing in a nearby clinic. Computed tomography revealed stenosis of the hilar bile duct. Accordingly, an endoscopic nasobiliary drainage tube was inserted in the left hepatic duct and she was referred to our hospital for diagnostic examinations and treatment. The endoscopic retrograde cholangiopancreatography findings revealed obstruction of the cystic duct and stenosis of the hilar bile duct due to inflammation of the cystic duct or inflammation of the clamping type by cholecystitis. Considering the possibility of malignant tumor, surgical operation was performed. Radical resection was considered impossible and we instead performed cholecystectomy and resection of a bile duct wall specimen for diagnosis. The pathological diagnosis was poorly differentiated tubular adenocarcinoma. The patient was treated with gemcitabine as systemic chemotherapy for unresectable hilar bile duct cancer. Currently, 78 months after the start of chemotherapy, the patient is alive and well, without tumor progression.
要旨
症例は69歳,女性。近医で血液検査で肝機能異常を指摘され,CT精査にて肝門部に限局した狭窄が認められた。左肝管にENBD挿入され,精査加療目的に当院紹介入院となった。ERCPで胆嚢管の閉塞と総肝管に狭窄が認められ,胆嚢管の炎症,もしくは胆嚢炎による締め付け型の炎症が考えられた。悪性腫瘍の疑いもあり,手術を施行した。根治的切除が困難であり,胆嚢摘出と診断目的に胆管壁を一部切除した。病理診断はpoorly differentiated tubular adenocarcinomaであった。切除不能局所進行胆管癌に対し,化学療法としてgemcitabine単剤療法を開始した。治療期間中に病変の進行はなく,投与開始から6年6か月経過し,現在も外来通院加療中である。
目次
Summary
A 69-year-old woman was diagnosed with liver dysfunction on blood testing in a nearby clinic. Computed tomography revealed stenosis of the hilar bile duct. Accordingly, an endoscopic nasobiliary drainage tube was inserted in the left hepatic duct and she was referred to our hospital for diagnostic examinations and treatment. The endoscopic retrograde cholangiopancreatography findings revealed obstruction of the cystic duct and stenosis of the hilar bile duct due to inflammation of the cystic duct or inflammation of the clamping type by cholecystitis. Considering the possibility of malignant tumor, surgical operation was performed. Radical resection was considered impossible and we instead performed cholecystectomy and resection of a bile duct wall specimen for diagnosis. The pathological diagnosis was poorly differentiated tubular adenocarcinoma. The patient was treated with gemcitabine as systemic chemotherapy for unresectable hilar bile duct cancer. Currently, 78 months after the start of chemotherapy, the patient is alive and well, without tumor progression.
要旨
症例は69歳,女性。近医で血液検査で肝機能異常を指摘され,CT精査にて肝門部に限局した狭窄が認められた。左肝管にENBD挿入され,精査加療目的に当院紹介入院となった。ERCPで胆嚢管の閉塞と総肝管に狭窄が認められ,胆嚢管の炎症,もしくは胆嚢炎による締め付け型の炎症が考えられた。悪性腫瘍の疑いもあり,手術を施行した。根治的切除が困難であり,胆嚢摘出と診断目的に胆管壁を一部切除した。病理診断はpoorly differentiated tubular adenocarcinomaであった。切除不能局所進行胆管癌に対し,化学療法としてgemcitabine単剤療法を開始した。治療期間中に病変の進行はなく,投与開始から6年6か月経過し,現在も外来通院加療中である。