胆嚢（GB）は腫大し，図１６で漿膜下浮腫を認め（△），図２１〜図２３で脂肪組織は濃度上昇を呈し（▲），図２４と図２５では結腸が浮腫性に壁肥厚を示している．図９〜図１２の二重丸（◎）は，胆嚢に接する肝臓辺縁の濃度上昇を示しており，急性胆嚢炎である．図１１〜図１８の↑の部分は他部位と違い局所的に肥厚し，不整に造影されている．図１９と図２０で胆嚢がいびつな形で変形しており，↑の壁肥厚は胆嚢癌の可能性を否定できない．図１〜図４で肝左葉と右葉の造影効果の相違は何を意味するのか？ 血流量の違いを表している可能性があるので図８から門脈を頭側へ追跡すると図４で造影されなくなり，さらに左門脈（側副路からの血流で再開通したと思われる）に比べ右門脈の造影効果が低下しており，図４と図５の白矢印が腫瘍栓である可能性が高く，胆嚢病変が悪性腫瘍であることを裏付ける．図８でIVCが虚脱しており強い脱水がある．腹部エコー検査でも同様な所見を示したのでPTGBDを施行し症状は改善した．

文献考察：急性胆嚢炎の1%に胆嚢癌を合併する．
Lancet Oncol. 2003 Mar;4(3):167-76.
Carcinoma of the gallbladder.
Misra S, Chaturvedi A, Misra NC, Sharma ID.

Carcinoma of the gallbladder is the most common malignant tumour of the biliary tract and a particularly high incidence is observed in Chile, Japan, and northern India. The aetiology of this tumour is complex, but there is a strong association with gallstones. Owing to its non-specific symptoms, gallbladder carcinoma is generally diagnosed late in the disease course, but if a patient with gallstones experiences a sudden change of symptoms, then a cancer diagnosis should be considered. Treatment with radical or extended cholecystectomy is potentially curative, although these procedures are only possible in 10-30% of patients. There is no role for cytoreductive surgery in this disease. If a gallbladder carcinoma is discovered via pathological examination of tissue samples, then the patient should be examined further and should have radical surgery if the tumour is found to be T1b or beyond. Additional port-site excision is necessary if the patient has already had their gallbladder removed during laparoscopy; however, patients with an intact gallbladder who are suspected to have gallbladder carcinoma should not undergo laparoscopic cholecystectomy. Patients with advanced inoperable disease should receive palliative treatment; however, the role of chemotherapy and radiation in these patients needs further evaluation.PMID: 12623362