術前診断にて胆管細胞癌との鑑別が困難であった肝孤立性壊死性結節の1手術例

肝孤立性壊死性結節は，中心壊死，硝子化線維性組織，弾性繊維を特徴とするまれな良性病変とされるが，術前診断困難で，発症機序も不明である．今回，胆管細胞癌などを疑ったが確診に至らず肝切除術を行い，肝孤立性壊死性結節と診断した1例を経験したので報告する．症例は64歳の男性で，他科でのCTで肝腫瘍影および肝胆道系酵素上昇を指摘され紹介となった．肝S4に3 cm弱の境界不明瞭な腫瘍影を認め，超音波で等エコー，MRIでT1WI低信号，T2WI高信号，造影CT，MRI，超音波では早期濃染を認めず，辺縁部に弱い造影効果を示した．他臓器に悪性所見を認めず，胆管細胞癌などを疑い肝内側区域切除術を施行したところ，病...

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Published in日本消化器外科学会雑誌 Vol. 47; no. 7; pp. 395 - 402
Main Authors 宮坂, 大介, 松永, 明宏, 宮谷内, 健吾, 池田, 淳一, 石津, 明洋, 新関, 浩人, 山口, 晃司, 山田, 徹, 須永, 道明
Format Journal Article
LanguageJapanese
Published 一般社団法人 日本消化器外科学会 2014
Subjects
孤立性壊死性結節
肝
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ISSN0386-9768
1348-9372
DOI10.5833/jjgs.2013.0191

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Abstract 肝孤立性壊死性結節は，中心壊死，硝子化線維性組織，弾性繊維を特徴とするまれな良性病変とされるが，術前診断困難で，発症機序も不明である．今回，胆管細胞癌などを疑ったが確診に至らず肝切除術を行い，肝孤立性壊死性結節と診断した1例を経験したので報告する．症例は64歳の男性で，他科でのCTで肝腫瘍影および肝胆道系酵素上昇を指摘され紹介となった．肝S4に3 cm弱の境界不明瞭な腫瘍影を認め，超音波で等エコー，MRIでT1WI低信号，T2WI高信号，造影CT，MRI，超音波では早期濃染を認めず，辺縁部に弱い造影効果を示した．他臓器に悪性所見を認めず，胆管細胞癌などを疑い肝内側区域切除術を施行したところ，病変部は肝孤立性壊死性結節，背景肝は原発性胆汁性肝硬変と診断された．11年前に肝S4に7 cm大の限局性結節性過形成もしくは炎症性偽腫瘍を疑う所見を指摘されていた経緯があり，あわせて報告する．
AbstractList 肝孤立性壊死性結節は，中心壊死，硝子化線維性組織，弾性繊維を特徴とするまれな良性病変とされるが，術前診断困難で，発症機序も不明である．今回，胆管細胞癌などを疑ったが確診に至らず肝切除術を行い，肝孤立性壊死性結節と診断した1例を経験したので報告する．症例は64歳の男性で，他科でのCTで肝腫瘍影および肝胆道系酵素上昇を指摘され紹介となった．肝S4に3 cm弱の境界不明瞭な腫瘍影を認め，超音波で等エコー，MRIでT1WI低信号，T2WI高信号，造影CT，MRI，超音波では早期濃染を認めず，辺縁部に弱い造影効果を示した．他臓器に悪性所見を認めず，胆管細胞癌などを疑い肝内側区域切除術を施行したところ，病変部は肝孤立性壊死性結節，背景肝は原発性胆汁性肝硬変と診断された．11年前に肝S4に7 cm大の限局性結節性過形成もしくは炎症性偽腫瘍を疑う所見を指摘されていた経緯があり，あわせて報告する．
Author 山口, 晃司
新関, 浩人
松永, 明宏
須永, 道明
宮坂, 大介
山田, 徹
宮谷内, 健吾
池田, 淳一
石津, 明洋
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References 8) Roberts KJ, Hubscher A, Mangat K, Sutcliffe R, Marudanayagam R. Pinworm infection masquerading as colorectal liver metastasis. Ann R Coll Surg Engl. 2012;94(6):e195–7.
15) Delis SG, Kelgiorgi DA, Sofianidis AA, Triantopoulou CC, Papailiou IA, Dervenis CG. Solitary necrotic nodule of the liver mimicking hepatocellular carcinoma: a case report. Cases J. 2009;2(1):85.
18) 庄中 達也，倉内 宣明，大川 由美，三澤 一仁，佐野 秀一．悪性腫瘍との鑑別が困難であった肝孤立性壊死性結節（solitary necrotic nodule）の1例．日本消化器病学会雑誌．2007;104(1):47–51.
10) Deniz K, Artis T, Tekelioqlu F, Ozcan S. Solitary necrotic nodule of the liver. J Gastrointestin Liver Dis. 2011;20(4):346.
32) Shepherd NA. Solitary necrotic nodule. J Clin Pathol. 1990;43(4):348–349.
6) 厚生労働科学研究費補助金難治性疾患克服研究事業「難治性の肝・胆道疾患に関する調査研究」班編．原発性胆汁性肝硬変（PBC）の診療ガイドライン（2011年），2011.
28) Cong W, Wu M, Wang Y, Chen H, Zhang X. Primary liver tumors in China. Oncol Rep. 1997;4(3):649–652.
31) Tsui WM, Yuen RW, Chow LT, Tse CC. Solitary necrotic nodule of the liver: parasitic origin? J Clin Pathol. 1992;45(11):975–978.
25) Iwase K, Higaki J, Yoon HE, Mikata S, Miyazaki M, Torikai K, et al. Solitary necrotic nodule of the liver. J Hepatobiliary Pancreat Surg. 2002;9(1):120–124.
34) 奥田 雄紀浩，寺嶋 宏明，山田 篤史，小西 二三男，川上 義行，廣瀬 由紀，ほか．Fluorine-18-Fluorodeoxy-Glucose Positron Emission Tomographyにて集積を認めず術前診断に苦慮した肝内胆管癌の1例．日本消化器外科学会雑誌．2009;42(2):198–203
13) Deniz K, Coban G. Solitary necrotic nodule of the liver: always benign? J Gastrointest Surg. 2010;14(3):536–540.
14) Otani K, Chijiiwa K, Kondo K, Tsuchimochi M, Takahashi N, Ikenaga N, et al. Enlarged solitary necrotic nodule of the liver misinterpreted as a metastatic liver cancer. Clin J Gastroenterol. 2009;2:355–360.
33) Berry CL. Solitary “necrotic nodule” of the liver: a probable pathogenesis. J Clin Pathol. 1985;38(11):1278–1280.
1) Geng L, Lin C, Huang B, Long XA, Dai BH, Cong WM, et al. Solitary necrotic nodule of the liver: MR findings in 33 pathologically proved lesions. Eur J Radiol. 2012;81(4):623–629.
16) Koea J, Smith D. Solitary necrotic nodule revisited. ANZ J Surg. 2008;78(1–2):109–111.
9) Noh SJ, Jachin S, Moon WS. Solitary necrotic nodule of the liver. Clin Mol Hepatol. 2012;18(2):235–238.
23) Koea J, Taylor G, Miller M, Rodgers M, McCall J. Solitary necrotic nodule of the liver: a riddle that is difficult to answer. J Gastrointest Surg. 2003;7(5):627–630.
27) Alfieri S, Carriero C, Doglietto GB, Pacelli F, Crucitti F. Solitary necrotic nodule of the liver: diagnosis and treatment. Hepatogastroenterology. 1997;44(16):1210–1211.
3) Sundaresan M, Lyons B, Akosa AB. ‘Solitary’ necrotic nodules of the liver: an aetiology reaffirmed. Gut. 1991;32(11):1378–1380.
36) Corvera CU, Blumgart LH, Akhurst T, DeMatteo RP, D’Angelica M, Fong Y, et al. 18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer. J Am Coll Surg. 2008;206(1):57–65.
19) Wang Y, Yu X, Tang J, Li H, Liu L, Gao Y. Solitary necrotic nodule of the liver: contrast-enhanced sonography. J Clin Ultrasound. 2007;35(4):177–181.
26) De Luca M, Luigi B, Formisano C, Formato A, De Werra C, Cappuccio M, et al. Solitary necrotic nodule of the liver misinterpreted as malignant lesion: considerations on two cases. J Surg Oncol. 2000;74(3):219–222.
2) Zhou YM, Li B, Xu F, Wang B, Li DQ, Liu P, et al. Clinical features of solitary necrotic nodule of the liver. Hepatobiliary Pancreat Dis Int. 2008;7(5):485–489.
5) Yoon KH, Yun KJ, Lee JM, Kim CG. Solitary necrotic nodules of the liver mimicking hepatic metastasis: report of two cases. Korean J Radiol. 2000;1(3):165–168.
7) Shepherd NA, Lee G. Solitary necrotic nodules of the liver simulating hepatic metastasis. J Clin Pathol. 1983;36(10):1181–1183.
29) Nakamura Y. Non-neoplastic nodular lesions in the liver. Pathol Int. 1995;45(10):703–714.
21) Kondi-Pafiti AI, Grapsa DS, Kairi-Vasilatou ED, Voros DK, Smyrniotis VE. “Solitary” necrotic nodule of the liver: an enigmatic entity mimicking malignancy. Int J Gastrointest Cancer. 2006;37(2–3):74–78.
30) Clouston AD, Walker NI, Prociv P. Parasitic origin of a solitary necrotic nodule of the liver. J Clin Pathol. 1993;46(6):578–581.
12) Chen CJ, Chou SC, Chen HJ, Chen HY. Solitary necrotic nodule with larval infestation in the liver on F-18 FDG PET/CT. Clin Nucl Med. 2010;35(9):724–725.
24) Endo Y, Hikita H, Hamada A, Oe K, Torii A, Nishikawa H, et al. A case of solitary necrotic nodule of the liver with acute liver dysfunction: the imaging appearance correlated with pathological findings. J Med Ultrasonics. 2003;30:193–198.
20) 斉坂 雄一，志摩 泰生，古北 由仁，西村 公男，黒瀬 洋平，小笠原 卓，ほか．肝孤立性壊死性結節の1例．高知市医師会医学雑誌．2007;12:187–191.
11) Choi CS, Cho EY, Jeong JS, Im CJ, Yang BJ, Kim HC. Spontaneous regression of a solitary necrotic nodule of the liver. Hepatol Int. 2010;4(3):649–652.
4) Colagrande S, Politi LS, Messerini L, Mascalchi M, Villari N. Solitary necrotic nodule of the liver: imaging and correlation with pathologic features. Abdom Imaging. 2003;28(1):41–44.
22) Imura S, Miyake K, Ikemoto T, Morine Y, Fujii M, Sano N, et al. Rapid-growing solitary necrotic nodule of the liver. J Med Invest. 2006;53(3–4):325–329.
17) Patti R, Cabibi D, Sparacello M, Di Vita G, Montalto G. Solitary necrotic nodule of the liver: differential pathological findings express a different histogenesis. Case Rep Gastroenterol. 2008;2(1):149–154.
35) Kim YJ, Yun M, Lee WJ, Kim KS, Lee JD. Usefulness of 18F-FDG PET in intrahepatic cholangiocarcinoma. Eur J Nucl Med Mol Imaging. 2003;30(11):1467–1472.
References_xml – reference: 16) Koea J, Smith D. Solitary necrotic nodule revisited. ANZ J Surg. 2008;78(1–2):109–111.
– reference: 18) 庄中 達也，倉内 宣明，大川 由美，三澤 一仁，佐野 秀一．悪性腫瘍との鑑別が困難であった肝孤立性壊死性結節（solitary necrotic nodule）の1例．日本消化器病学会雑誌．2007;104(1):47–51.
– reference: 6) 厚生労働科学研究費補助金難治性疾患克服研究事業「難治性の肝・胆道疾患に関する調査研究」班編．原発性胆汁性肝硬変（PBC）の診療ガイドライン（2011年），2011.
– reference: 2) Zhou YM, Li B, Xu F, Wang B, Li DQ, Liu P, et al. Clinical features of solitary necrotic nodule of the liver. Hepatobiliary Pancreat Dis Int. 2008;7(5):485–489.
– reference: 9) Noh SJ, Jachin S, Moon WS. Solitary necrotic nodule of the liver. Clin Mol Hepatol. 2012;18(2):235–238.
– reference: 14) Otani K, Chijiiwa K, Kondo K, Tsuchimochi M, Takahashi N, Ikenaga N, et al. Enlarged solitary necrotic nodule of the liver misinterpreted as a metastatic liver cancer. Clin J Gastroenterol. 2009;2:355–360.
– reference: 4) Colagrande S, Politi LS, Messerini L, Mascalchi M, Villari N. Solitary necrotic nodule of the liver: imaging and correlation with pathologic features. Abdom Imaging. 2003;28(1):41–44.
– reference: 33) Berry CL. Solitary “necrotic nodule” of the liver: a probable pathogenesis. J Clin Pathol. 1985;38(11):1278–1280.
– reference: 19) Wang Y, Yu X, Tang J, Li H, Liu L, Gao Y. Solitary necrotic nodule of the liver: contrast-enhanced sonography. J Clin Ultrasound. 2007;35(4):177–181.
– reference: 24) Endo Y, Hikita H, Hamada A, Oe K, Torii A, Nishikawa H, et al. A case of solitary necrotic nodule of the liver with acute liver dysfunction: the imaging appearance correlated with pathological findings. J Med Ultrasonics. 2003;30:193–198.
– reference: 1) Geng L, Lin C, Huang B, Long XA, Dai BH, Cong WM, et al. Solitary necrotic nodule of the liver: MR findings in 33 pathologically proved lesions. Eur J Radiol. 2012;81(4):623–629.
– reference: 31) Tsui WM, Yuen RW, Chow LT, Tse CC. Solitary necrotic nodule of the liver: parasitic origin? J Clin Pathol. 1992;45(11):975–978.
– reference: 26) De Luca M, Luigi B, Formisano C, Formato A, De Werra C, Cappuccio M, et al. Solitary necrotic nodule of the liver misinterpreted as malignant lesion: considerations on two cases. J Surg Oncol. 2000;74(3):219–222.
– reference: 17) Patti R, Cabibi D, Sparacello M, Di Vita G, Montalto G. Solitary necrotic nodule of the liver: differential pathological findings express a different histogenesis. Case Rep Gastroenterol. 2008;2(1):149–154.
– reference: 29) Nakamura Y. Non-neoplastic nodular lesions in the liver. Pathol Int. 1995;45(10):703–714.
– reference: 23) Koea J, Taylor G, Miller M, Rodgers M, McCall J. Solitary necrotic nodule of the liver: a riddle that is difficult to answer. J Gastrointest Surg. 2003;7(5):627–630.
– reference: 8) Roberts KJ, Hubscher A, Mangat K, Sutcliffe R, Marudanayagam R. Pinworm infection masquerading as colorectal liver metastasis. Ann R Coll Surg Engl. 2012;94(6):e195–7.
– reference: 15) Delis SG, Kelgiorgi DA, Sofianidis AA, Triantopoulou CC, Papailiou IA, Dervenis CG. Solitary necrotic nodule of the liver mimicking hepatocellular carcinoma: a case report. Cases J. 2009;2(1):85.
– reference: 20) 斉坂 雄一，志摩 泰生，古北 由仁，西村 公男，黒瀬 洋平，小笠原 卓，ほか．肝孤立性壊死性結節の1例．高知市医師会医学雑誌．2007;12:187–191.
– reference: 35) Kim YJ, Yun M, Lee WJ, Kim KS, Lee JD. Usefulness of 18F-FDG PET in intrahepatic cholangiocarcinoma. Eur J Nucl Med Mol Imaging. 2003;30(11):1467–1472.
– reference: 25) Iwase K, Higaki J, Yoon HE, Mikata S, Miyazaki M, Torikai K, et al. Solitary necrotic nodule of the liver. J Hepatobiliary Pancreat Surg. 2002;9(1):120–124.
– reference: 3) Sundaresan M, Lyons B, Akosa AB. ‘Solitary’ necrotic nodules of the liver: an aetiology reaffirmed. Gut. 1991;32(11):1378–1380.
– reference: 7) Shepherd NA, Lee G. Solitary necrotic nodules of the liver simulating hepatic metastasis. J Clin Pathol. 1983;36(10):1181–1183.
– reference: 13) Deniz K, Coban G. Solitary necrotic nodule of the liver: always benign? J Gastrointest Surg. 2010;14(3):536–540.
– reference: 28) Cong W, Wu M, Wang Y, Chen H, Zhang X. Primary liver tumors in China. Oncol Rep. 1997;4(3):649–652.
– reference: 30) Clouston AD, Walker NI, Prociv P. Parasitic origin of a solitary necrotic nodule of the liver. J Clin Pathol. 1993;46(6):578–581.
– reference: 11) Choi CS, Cho EY, Jeong JS, Im CJ, Yang BJ, Kim HC. Spontaneous regression of a solitary necrotic nodule of the liver. Hepatol Int. 2010;4(3):649–652.
– reference: 12) Chen CJ, Chou SC, Chen HJ, Chen HY. Solitary necrotic nodule with larval infestation in the liver on F-18 FDG PET/CT. Clin Nucl Med. 2010;35(9):724–725.
– reference: 27) Alfieri S, Carriero C, Doglietto GB, Pacelli F, Crucitti F. Solitary necrotic nodule of the liver: diagnosis and treatment. Hepatogastroenterology. 1997;44(16):1210–1211.
– reference: 5) Yoon KH, Yun KJ, Lee JM, Kim CG. Solitary necrotic nodules of the liver mimicking hepatic metastasis: report of two cases. Korean J Radiol. 2000;1(3):165–168.
– reference: 21) Kondi-Pafiti AI, Grapsa DS, Kairi-Vasilatou ED, Voros DK, Smyrniotis VE. “Solitary” necrotic nodule of the liver: an enigmatic entity mimicking malignancy. Int J Gastrointest Cancer. 2006;37(2–3):74–78.
– reference: 32) Shepherd NA. Solitary necrotic nodule. J Clin Pathol. 1990;43(4):348–349.
– reference: 10) Deniz K, Artis T, Tekelioqlu F, Ozcan S. Solitary necrotic nodule of the liver. J Gastrointestin Liver Dis. 2011;20(4):346.
– reference: 22) Imura S, Miyake K, Ikemoto T, Morine Y, Fujii M, Sano N, et al. Rapid-growing solitary necrotic nodule of the liver. J Med Invest. 2006;53(3–4):325–329.
– reference: 34) 奥田 雄紀浩，寺嶋 宏明，山田 篤史，小西 二三男，川上 義行，廣瀬 由紀，ほか．Fluorine-18-Fluorodeoxy-Glucose Positron Emission Tomographyにて集積を認めず術前診断に苦慮した肝内胆管癌の1例．日本消化器外科学会雑誌．2009;42(2):198–203．
– reference: 36) Corvera CU, Blumgart LH, Akhurst T, DeMatteo RP, D’Angelica M, Fong Y, et al. 18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer. J Am Coll Surg. 2008;206(1):57–65.
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肝
Title 術前診断にて胆管細胞癌との鑑別が困難であった肝孤立性壊死性結節の1手術例
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ispartofPNX 日本消化器外科学会雑誌, 2014/07/01, Vol.47(7), pp.395-402
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