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{'症例は68歳,男性.黄疸を主訴に受診し総ビリルビン13.6mg/dlと高値,腹部CTにて総胆管,肝内胆管の拡張を認めた.閉塞性黄疸の診断にて経皮経肝胆道ドレナージを施行し下部胆管に閉塞所見を認めた.胆汁細胞診ではclassIであり,CEA,CA19-9,DUPAN-IIは正常範囲内であった.しかし,画像所見上,下部胆管癌が強く疑われ,幽門輪温存膵頭十二指腸切除を施行した.切除標本のHE染色では癌様の腺腔構造と紡錘形で充実束状を示すものがあり,両者は移行を示しており,免疫染色ではケラチン,サイトケラチンは両者に陽性,ビメンチンは肉腫部分で陽性であり,いわゆる癌肉腫の所見であった.組織学的にはBi,circ,乳頭浸潤型,2.2×1.5cm,t2,panclb,hinf0,ginf0,du0,pv0,a0,s0,ly1,v0,hm0,dm0,em0,n1,stage2,curBであった.術後4カ月目に肝転移を認め術後8カ月で死亡した.胆嚢を除く肝外胆管原発の癌肉腫の報告例はきわめてまれであり本邦では19例の報告をみるのみで,まれな症例を経験したので文献的考察を含め報告した.': [0]}, 'cited_by_api_url': 'https://api.openalex.org/works?filter=cites:W2318386822', 'counts_by_year': [{'year': 2022, 'cited_by_count': 1}, {'year': 2021, 'cited_by_count': 1}, {'year': 2014, 'cited_by_count': 1}, {'year': 2013, 'cited_by_count': 1}, {'year': 2012, 'cited_by_count': 1}], 'updated_date': '2024-09-14T17:22:19.199511', 'created_date': '2016-06-24'}