{"created":"2021-03-01T06:13:00.676001+00:00","id":8964,"links":{},"metadata":{"_buckets":{"deposit":"17b91d79-4dbd-4be0-8398-64a8fe33130c"},"_deposit":{"id":"8964","owners":[],"pid":{"revision_id":0,"type":"depid","value":"8964"},"status":"published"},"_oai":{"id":"oai:niigata-u.repo.nii.ac.jp:00008964","sets":["453:456","471:537:538:920"]},"item_7_alternative_title_1":{"attribute_name":"その他のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"Colorectal Carcinoma Liver Matastasis with Bile Duct Involvement Different to Differenciate from Intrahepatic Cholangiocarcinoma : Report of Two Cases"}]},"item_7_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2014-06","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"6","bibliographicPageEnd":"275","bibliographicPageStart":"269","bibliographicVolumeNumber":"128","bibliographic_titles":[{"bibliographic_title":"新潟医学会雑誌"},{"bibliographic_title":"新潟医学会雑誌","bibliographic_titleLang":"en"}]}]},"item_7_description_4":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"【目的】大腸癌肝転移と肝内胆管癌は両者ともに腺癌であり, 画像検査や腫瘍マーカー等も類似した所見を示すことが多い. 今回我々は, 術前に肝内胆管癌との鑑別が困難であり, 切除標本の免疫組織化学により診断可能となった胆管浸潤を伴う大腸癌肝転移の2例を経験したので報告する. 【対象・方法】対象となった2例はいずれも過去に大腸癌に対する根治手術を施行されていた. 腹部CT検査で胆管浸潤を伴う肝腫瘤を指摘され, 術前に大腸癌肝転移と肝内胆管癌との鑑別は困難であった. 切除標本の免疫組織化学により, 両者の鑑別診断を行った. 【結果】「症例1」: 71歳, 男性. 直腸癌Stage Iに対する手術施行後4年7か月の腹部CT検査で肝右葉に腫瘤を指摘された. 肝内胆管後区域枝および尾状葉枝に拡張を認め, 胆管浸潤が疑われた. 肝内胆管後区域枝および尾状葉枝に腫瘍栓を認め, 肝右葉切除・尾状葉切除・肝外胆管切除が施行された. 「症例2」: 75歳, 女性. 上行結腸癌Stage IIに対する手術後2年5か月の腹部CT検査で肝後区域に腫瘤を指摘された. 大腸癌肝転移を疑われ, 全身化学療法を施行されたが反応性は明らかでなく, 腫瘤の胆管浸潤も認められるようになったため, 肝右葉切除・肝外胆管切除が施行された. いずれの症例も, 腫瘍細胞はCytokeratin(CK)7陰性, CK20陽性を示し, 組織学的に大腸癌肝転移と診断された. 【考察】胆管浸潤は肝内胆管癌に特徴的な画像所見とされている. 今回経験した大腸癌肝転移の2例はいずれも胆管浸潤所見が認められ, 肝内胆管癌との鑑別は画像上困難であった. 両者の鑑別診断に際しては大腸癌既往に関する情報が重要であるが, 大腸癌原発巣の切除から時間が経過した異時性再発例や化学療法への反応性が乏しい場合, 術前診断は容易ではない. 大腸癌肝転移と肝内胆管癌の病理診断において, 免疫組織化学の有用性が報告されている. 大腸上皮マーカーであるCK20と胆管上皮マーカーであるCK7の組み合わせにより正確な組織診断が可能となる. 2例ともCK7陰性かつCK20陽性であり, 大腸癌肝転移と診断する強い根拠となった. 【結論】肝内胆管癌との鑑別が困難であった胆管浸潤を伴う大腸癌肝転移の2切除例を経験した. 両者の鑑別診断にはCK7, CK20に対する免疫組織化学が有用である. 免疫組織化学による正確な鑑別診断により, 適切な薬物療法の選択が可能となる.","subitem_description_type":"Abstract"}]},"item_7_full_name_3":{"attribute_name":"著者別名","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"62465","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Sudo, Natsuru"}]},{"nameIdentifiers":[{"nameIdentifier":"62466","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Hirose, Yuki"}]},{"nameIdentifiers":[{"nameIdentifier":"62467","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Ishikawa, Hirosuke"}]},{"nameIdentifiers":[{"nameIdentifier":"62468","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Katada, Tomohiro"}]},{"nameIdentifiers":[{"nameIdentifier":"62469","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Saito, Keita"}]},{"nameIdentifiers":[{"nameIdentifier":"62470","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Takizawa, Kazuyasu"}]},{"nameIdentifiers":[{"nameIdentifier":"62471","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Takano, Kabuto"}]},{"nameIdentifiers":[{"nameIdentifier":"62472","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Sakata, Jun"}]},{"nameIdentifiers":[{"nameIdentifier":"62473","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Kobayashi, Takashi"}]},{"nameIdentifiers":[{"nameIdentifier":"62474","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Minagawa, Masahiro"}]},{"nameIdentifiers":[{"nameIdentifier":"62475","nameIdentifierScheme":"WEKO"}],"names":[{"name":"Wakui, Toshifumi"}]}]},"item_7_publisher_7":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"新潟医学会"}]},"item_7_select_19":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_select_item":"publisher"}]},"item_7_source_id_11":{"attribute_name":"書誌レコードID","attribute_value_mlt":[{"subitem_source_identifier":"AN00182415","subitem_source_identifier_type":"NCID"}]},"item_7_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"00290440","subitem_source_identifier_type":"ISSN"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"須藤, 翔"}],"nameIdentifiers":[{"nameIdentifier":"62454","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"廣瀬, 雄巳"}],"nameIdentifiers":[{"nameIdentifier":"62455","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"石川, 博補"}],"nameIdentifiers":[{"nameIdentifier":"62456","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"堅田, 朋大"}],"nameIdentifiers":[{"nameIdentifier":"62457","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"斉藤, 敬太"}],"nameIdentifiers":[{"nameIdentifier":"62458","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"滝沢, 一泰"}],"nameIdentifiers":[{"nameIdentifier":"62459","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"高野, 可赴"}],"nameIdentifiers":[{"nameIdentifier":"62460","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"坂田, 純"}],"nameIdentifiers":[{"nameIdentifier":"62461","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"小林, 隆"}],"nameIdentifiers":[{"nameIdentifier":"62462","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"皆川, 昌広"}],"nameIdentifiers":[{"nameIdentifier":"62463","nameIdentifierScheme":"WEKO"}]},{"creatorNames":[{"creatorName":"若井, 俊文"}],"nameIdentifiers":[{"nameIdentifier":"62464","nameIdentifierScheme":"WEKO"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2019-08-06"}],"displaytype":"detail","filename":"128(6)_269-275.pdf","filesize":[{"value":"3.6 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"128(6)_269-275.pdf","url":"https://niigata-u.repo.nii.ac.jp/record/8964/files/128(6)_269-275.pdf"},"version_id":"64eefda3-f1c9-4e5d-850b-4499cefa0a43"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"大腸癌肝転移","subitem_subject_scheme":"Other"},{"subitem_subject":"肝内胆管癌","subitem_subject_scheme":"Other"},{"subitem_subject":"Cytokeratin","subitem_subject_scheme":"Other"},{"subitem_subject":"免疫組織化学","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"departmental bulletin 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