Yoshitsugu Nakanishi

Patients with positive ductal margins of carcinoma in situ of the extrahepatic bile duct do not appear to show different survival after resection compared to patients with negative margins, but remnant carcinoma in situ is likely to develop late local recurrence.

Preoperative s-CA19-9 appears useful as a biomarker in patients with ICC, for predicting not only lymph node metastasis but also prognosis after surgical resection with curative intent.

Intraductal papillary neoplasms of the bile duct are generally thought to arise from neoplastic papillary proliferation of epithelial cells lining the bile duct. We herein report a case with findings that strongly suggested that the biliary cystic tumor might have derived from a peribiliary gland. A 69-year-old female was found to have a cystic lesion with intracystic protrusions at the anterior segment of the right hepatic lobe and underwent hepatic anterior segment resection. Fluoroscopy of th

This study clarified differences in risk factors between various patterns of recurrence. Careful examination of risk factors could help prevent oversight of recurrences and improve detection of recurrences during follow-up. The number of lymph node metastases represents an independent risk factor for all three patterns of recurrence; thus, patients with multiple lymph node metastases warrant particular attention.

Tumor budding appears to be an indicator of tumor growth and invasiveness. Patients with low-grade budding are likely to have a better prognosis than those with high-grade budding, but the tumor may recur in the late phase postoperatively in patients with low-grade budding.

Higher tumour budding grade is associated with invasive clinicopathological features, adverse postoperative prognosis and EMT status in extrahepatic cholangiocarcinoma.

Occult cancer cells were present in regional lymph nodes of 22% patients with regional node-negative biliary cancer, and were associated with significantly worse survival. Patients with micrometastases should be treated as carefully as node-positive patients.

症例は69歳の男性で, 心窩部痛, 背部痛を主訴に来院した. USでは膵体部にhyperechoic spotを内部に含む, 約1.6cmの低エコー腫瘤を, 造影USで内部に染影効果を認めた. 造影CTでは, 腫瘤は内部均一の造影効果を認めた. 生検で膵癌と診断し, 膵体尾部切除を施行した. 肉眼的には腫瘍の1部分は主膵管内にポリープ状に突出していた. 病理学的には腫瘍は1.5cm径で紡錘細胞があたかも癌腺管の間質を形成するがごとくに両者が入り混じる形態を示していた. また, 主病巣に連続して上皮内癌が近傍の主膵管および分枝膵管内に進展していた. 以上より, 退形成性膵管癌の紡錘細胞型と診断した. 術後5か月目に左上腹部後腹膜に腫瘤を認めた. 術後6か月目にはVater乳頭部にも腫瘤が出現し, 生検でsarcomatous成分からなる腫瘍と判明した. 7か月目には肝転移も出現し, 8か月目に死亡した.