胆管癌を合併した肝吸虫症の１例

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  • A case report of clonorchiasis associated with a carcinoma of extrahepatic bile duct.

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We reported a case of clonorchiasis associated with an extrahepatic bile duct carcinoma diagnosed on the basis of cytological findings in the bile taken from the PTCD. The patient, a 66-year-old male who was admitted to the hospital with a chief complaint of chest discomfort and epigastric pain. An electrocardiogram failed to reveal any evidence of ischemic heart disease. After admission he developed obstructive jaundice, then underwent PTCD and cytological examination of the bile. The cytology examination revealed infection with Clonorchis sinensis possibly associated with malignancy. Although surgery was planned on the assumption of a diagnosis of bile duct cancer, no radical operability was determined so incisonal biopsy of the common bile duct from the tumor, lymphadnectomy and choledochojejunostomy were performed. The pathological diagnosis was poorly differentiated adenocarcinoma with metastasis to a regional lymphnode. After surgery, an adult Clonorchis worm was obtained from the PTC drain, and the diagnosis was confirmed. Although there is a well known close relationship between long-standing clonorchiasis and cholangiocarcinomas, this parasitic disease of the biliary tract must be considered a risk factor for both intra and extra-hepatic bile duct carcinoma, and early diagnosis and treatment are very important in preventing the most grave consequence of clonorchiasis.

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