바터 팽대부에 발생한 반지 세포암 1예
A Case of Signet-ring Cell Carcinoma of the Ampulla of Vater
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초록
소화관에서 주로 발생하는 반지 세포암은 대부분은 위에서 발생하며, 바터 팽대부에서 발생하는 경우는 극히 드물어 지금까지 16예 정도가 보고되었다. 47세의 남자가 10일 전부터 발생한 상복부 통증과 황달을 주소로 내원하였다. 컴퓨터 단층촬영과 초음파 검사에서 총담관 및 간내담관의 확장 소견이 관찰되었다. 십이지장경 검사에서 바터 팽대부에 불규칙한 표면을 가진 종괴가 돌출되어 있었고 조직 검사에서 반지 세포암으로 진단되었다. 3차 병원으로 전원하여 수술을 시도했으나 림프절 전이가 발견되어 근치적 수술을 하지 못하고 항암 치료 및 스텐트 삽입을 통한 담즙배액 등을 시행하였으며 발병 1년 후 사망 하였다. 저자들은 바터 팽대부에 발생한 반지 세포암 1예를 경험하여 문헌고찰과 함께 보고한다.
Abstract
Signet-ring cell carcinoma of the ampulla of Vater is so rare that only 16 cases have been reported. Here we report a case of a 47-year-old man with signet-ring cell carcinoma in the ampulla of Vater. The patient was hospitalized for right upper quadrant abdominal pain and jaundice which had developed 10 days prior. Computed tomography (CT) and ultrasonography (US) revealed dilatation of the common bile duct and the intrahepatic bile duct. On duodenoscopy, a bulging mass with an irregular margin in the major papilla was noted. Histologic findings showed a signet-ring cell carcinoma. Surgical resection was not done because lymph node metastasis was noted during the operation. Hence, conservative treatment including chemotherapy and bile drainage was done.
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