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症例は49歳の女性で，近医で肝機能異常とCA19-9の高値を認め腹部CT施行，胆嚢腫瘍と左卵巣腫瘍を指摘され精査加療目的に当科紹介された．腹部CT, MRIで胆嚢に不整な壁肥厚と乳頭状隆起を認め，骨盤腔内に14 cm大の多房性嚢胞を認めた．胆嚢と卵巣の重複癌の診断にて開腹手術を施行したが，胆嚢癌は腹膜転移を伴っており総肝動脈幹リンパ節のサンプリングと両側附属器切除のみを施行した．手術時に採取したリンパ節と左卵巣腫瘍はともに腺癌で，免疫組織染色検査にていずれもCA19-9陽性，cytokeratin 7陽性，cytokeratin 20陽性，p53陽性であり，一元的に胆嚢癌のリンパ節転移，卵巣転移と診断した．消化管腫瘍の卵巣転移のうち，胆嚢癌由来はまれである．本例はジェムシタビン，TS-1による化学療法を行い，術後21か月生存した．

A 69-year-old man diagnosed as having gallbladder cancer with liver invasion and metastasis to Couinaud's hepatic segment 8 (S8) was referred to our hospital. Because of the presence of liver metastasis, gemcitabine administration was chosen. Although gemcitabine was effective for the liver metastasis, his serum carcinoembryonic antigen (CEA) level had gradually increased after 12 cycles of gemcitabine administration. There was no distant metastasis other than the liver metastasis (manageable with gemcitabine) on detailed radiological examination. Therefore, we performed surgery for the primary lesion, after obtaining informed consent. Pathological examination demonstrated viable cancer cells with necrosis and fibrosis in the gallbladder, and fibrosis without viable cancer cells in the induration in liver S8. Gemcitabine was re-administered as postoperative adjuvant chemotherapy. Twenty months after the surgery, there was no sign of recurrence. In selected patients, gemcitabine treatment may be effective against gallbladder cancer with metastasis.

Background and Objectives The presence of lymph node (LN) metastases is an important prognostic factor in patients with biliary cancers. The aim of this study was to characterize systematically the morphological features of metastatic LNs in biliary cancers. Methods Four hundred ninety-six LNs (including 112 para-aortic LNs) dissected from 47 patients with biliary cancer were examined. The diameter of the long axis (size) and the percent metastatic area relative to whole-node area were measured from histologic specimens. Results The average size of metastatic LNs (9.5 mm) was significantly larger than those without metastasis (6.5 mm; P 7.5 mm, but the sensitivity of this predictor of metastasis was low (60.8%). In general, metastatic area correlated significantly with the size of metastatic LNs (P = 0.023). Para-aortic LNs contained metastasis in 7.1% of cases, and only 25% of para-aortic LNs with a high ratio of metastatic area could be evaluated from preoperative CT scans. Although large LNs are highly suggestive of metastasis, poor detection of many small LNs with a low percentage of metastatic area can increase risk in patients with biliary tract cancer. J. Surg. Oncol. 2008;97:423–427. © 2008 Wiley-Liss, Inc. Although large LNs are highly suggestive of metastasis, poor detection of many small LNs with a low percentage of metastatic area can increase risk in patients with biliary tract cancer. J. Surg. Oncol. © 2008 Wiley-Liss, Inc.