Biliary Microhamartoma in a Patient with Esophagogastric Junction Cancer That Resembled a Metastatic Liver Tumor and Significantly Influenced the Surgical Indication: Report of a Case

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  • Shimada Yuki
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Ohuchida Kenoki
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Matsumoto Takashi
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Shindo Koji
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Moriyama Taiki
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Mizuuchi Yusuke
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Nakata Kohei
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University
  • Yamamoto Takeo
    Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University
  • Hashisako Mikiko
    Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University
  • Oda Yoshinao
    Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University
  • Nakamura Masafumi
    Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University

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  • 転移性肝腫瘍との鑑別が困難で手術適応の判断に影響した胆管過誤腫併存食道胃接合部癌の1例

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<p>A 69-year-old woman underwent surgery for esophagogastric junction cancer. Multiple subcapsular nodules of several millimeters in size were identified on the liver surface and diagnosed as liver metastases based on pathological examination. Staging laparoscopy was performed after 2 courses of chemotherapy and the same nodules were detected, but the pathological diagnosis was biliary microhamartoma. Finally, the patient underwent curative surgery. In this case, thermal effects of the ultrasonic energy device with an inadequate resection margin in the initial partial hepatectomy was a major obstacle to pathological diagnosis. In addition, the primary lesion was a well differentiated tumor without severe atypia, which could increase the difficulty in pathological diagnosis. This rare entity should be listed as a differential diagnosis of small nodules of the liver, especially when coexisting with gastrointestinal cancers. This report suggests the importance of obtaining a sufficient amount of liver specimens without thermal artifacts, since such artifacts may cause inappropriate identification of structural and morphological findings of tissue components, leading to diagnostic pitfalls.</p>

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