Abstract
症例は75歳，女性．心窩部痛と背部痛で当科受診．肝機能障害があり，MRCPで下部胆管内に総胆管結石を認めた．内視鏡的乳頭切開術（EST）施行時，切開部の十二指腸乳頭部から乳頭状腫瘍を認め，生検施行．病理結果で胆管内乳頭状腫瘍（IPNB）が疑われた．EUSで乳頭部付近の下部胆管内に約１cm大の低エコー腫瘤が描出され，胆道鏡で下部胆管に一部壁不整を認めた．IPNB，下部胆管癌の疑いで亜全胃温存膵頭十二指腸切除術を施行した．病理検査で，周囲正常胆管粘膜から連続し，異型が混在する円柱上皮の一部に腺癌を粘膜内に認めた．免疫染色でMAC5ACとMAC6が染色された．胆管内発育型胆管癌とIPNBの明確な鑑別はないが，IPNB由来の腺癌の可能性が否定できなかった．下部胆管に発生し，EST後の直視下生検によって術前診断しえたIPNB由来の腺癌を経験したので報告する．
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