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A 68-year-old man underwent a partial resection of the liver and lymph node dissection for a tumor, 3.0cm in diameter, in S4 of the liver under the diagnosis of cholangiocellular carcinoma (CCC). The ...histological diagnosis was cholangiolocellular carcinoma (CoCC) and lymphatic permeation and venous invasion were recognized. Seven months after surgery, CT demonstrated two recurrent nodules in S7 and S8 of the liver, then a partial resection of the liver was performed. The gross and pathological findings were the same as the previously resected tumor. Four months after the second operation, CT demonstrated dilated intrahepatic bile ducts and lymph node swelling of the hepatic hilum. The patient died of disease thirteen months after the first operation. On the basis of the clinical and pathological features of this case, we consider that CoCC clinically resembles CCC and prognosis may be unfavorable, although it has characteristic pathological findings. It is still controversial whether CoCC should be accepted as a separate entity. The significance of repeat hepatectomy for recurrence and adjuvant chemotherapy should be clarified to improve the prognosis of CoCC.
68才，男性．肝S4の径3cmの胆管細胞癌の診断で肝部分切除およびリンパ節廓清術を施行した．病理組織診断は細胆管細胞癌でリンパ管侵襲と静脈侵襲を伴っていた．7ヶ月後のCTで肝S7とS8に2個の再発腫瘍を認めたため，再肝切除術を行った．肉眼および病理所見は前回の腫瘍と同様であった．2回目の手術から4ヶ月後のCTで肝内胆管の拡張と肝門部のリンパ節腫大を認め，初回手術から13ヶ月後に癌死した．本症例の臨床病理学的特徴からは，細胆管細胞癌は特異的な病理学的特徴を有するものの，臨床的には胆管細胞癌と類似し予後不良であると考えられる．細胆管細胞癌の予後の向上のために，再発に対する再肝切除や補助化学療法の意義を明らかにすべきである．続きを見る
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