臨牀消化器内科 Vol.26 No.13(1)


特集名 肝門部〜肝内胆管癌
題名 肝門部〜肝内胆管癌の病理
発刊年月 2011年 12月
著者 中沼 安二 金沢大学大学院医学系研究科形態機能病理学
著者 佐々木 素子 金沢大学大学院医学系研究科形態機能病理学
著者 佐藤 保則 金沢大学大学院医学系研究科形態機能病理学
著者 原田 憲一 金沢大学大学院医学系研究科形態機能病理学
著者 池田 博子 金沢大学附属病院病理部
【 要旨 】 肝門部胆管癌および肝内胆管癌を解剖学的部位に従い解説した．胆道癌に分類される肝門部胆管癌と肝内胆管癌に分類される傍肝門型の肝内胆管癌は肉眼像，組織像が類似しており，鑑別が困難な症例がみられ，傍肝門型胆管癌に含めて分類するのも一つの選択肢と考えられる．また，肝外胆管と肝内大型胆管の内腔に乳頭状に発育する腫瘍は胆管内乳頭状腫瘍（IPNB）と呼称され，胆管内腔の拡張を伴い，肝胆の粘液囊胞性腫瘍（MCN）との鑑別が必要である．MCNでは，卵巣様の間質を伴うのが特徴であり，エストロゲン受容体，プロゲステロン受容体を発現する．末梢型の肝内胆管癌(胆管細胞癌)は，腫瘤形成型の肉眼像を示すことが多い．
Theme Hilar and Intrahepatic Cholangiocarcinoma
Title Pathology of Hilar and Intrahepatic Cholangiocarcinoma
Author Yasuni Nakanuma Department of Human Pathology, Kanazawa University Graduate School of Medicine
Author Motoko Sasaki Department of Human Pathology, Kanazawa University Graduate School of Medicine
Author Yasunori Sato Department of Human Pathology, Kanazawa University Graduate School of Medicine
Author Kenichi Harada Department of Human Pathology, Kanazawa University Graduate School of Medicine
Author Hiroko Ikeda Pathology Diagnosis Service Section, Kanazawa University Hospital
[ Summary ] Hilar cholangiocarcinoma and intrahepatic cholangiocarcinoma are reviewed in respect to anatomical location. Hilar cholangiocarcinoma is related to biliary tract carcinoma and intrahepatic cholangiocarcinoma of the perihilar area. They resemble each other grossly and histologically. They may be included in a unified concept of perihilar cholangiocarcinoma. Intraductal growing type biliary neoplasms, which occur in the intrahepatic and extrahepatic bile ducts, exhibit luminal dilatation and not infrequently mucin secretion. This type of neoplasm resembles mucinous cystic neoplasms of the hepatobiliary system. However, in the latter, ovarianlike stroma expressing progesterone and estrogen receptors are present. Intrahepatic cholagiocarcinoma, of the peripheral type, exhibit a mass-forming pattern, which is grossly different from perihilar intrahepatic cholangiocarcinoma.
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