Klatskin암과 유두부암의 동시성 중복암 1예
A Case of Synchronous Double Cancer -Klatskin's Tumor and Ampullary Adenocarcinoma-
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중복암은 서로 다른 장기에 조직학적으로 같거나, 두가지 이상의 종양이 원발성으로 발생한 것을 말한다. 담도에 발생한 중복암은 드물게 보고되고 있고, 대부분 담낭과 총담관에 발생한 원발성 중복암에 관한 보고이며, 간외담관과 유두부에 발생한 중복암에 관한 보고는 없다. 57세 남자 환자가 내원 15일 전부터 시작된 적갈색뇨, 황달 및 전신 무기력증을 주소로 내원하였다. 복부 초음파 검사에서 간내 담관, 총 담관 및 담낭이 확장되어 있었으며, 내시경 검사에서 주유두부에 팽대성 종괴가 발견되었고, 조직검사에서 유두부 선암으로 진단되었다. 복부 단층 촬영, 내시경 역행성 담췌관 조영술 및 자기공명담 췌관조영술에서 총간관 합류부의 종괴가 발견되어 간외담관과 유두부에 발생한 동시성 중복암으로 진단하였다
Abstract
Multiple cancers in the extrahepatic biliary tree are relatively rare. Many such cases are a double cancer of the common bile duct and the gallbladder. We report a case of a double primary cancer that occurred synchronously at the hilum of the extrahepatic duct and the ampulla of Vater with a review of the relevant literature. A 57-year-old man was admitted to our institution after a 15 day of painless jaundice and a urine color change. Ultrasonography showed a dilation of both intrahepatic ducts. Upper endoscopy revealed a protruding ulcerative mass at the ampulla of Vater and endoscopic retrograde cholangiography showed a dilated common bile duct and a mildly dilatated pancreatic duct, but both intrahepatic bile ducts were not visualized. An upper abdominal CT scan showed a dilation of both intrahepatic bile ducts and an infiltrating mass at the bifurcation area. Magnetic resonance cholangiopanreatography showed narrowing bile duct lumen that was obstructed by the tumor at the hepatic duct bifurcation, which dilated both intrahepatic ducts. A histological examination of the ampulla of Vater revealed a well differentiated adenocarcinoma of the ampulla of Vater. The final diagnosis was a synchronous double cancer of Klatskin's tumor and an adenocarcinoma of the ampulla of Vater.
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