八木 秀文¹, 仲吉 昭夫¹, 高橋 博義¹, 田村 敏則¹, 緑川 武正¹, 大野 勝之¹, 清水 浩二¹, 木村 一雄¹, 成原 健太郎¹, 諸星 利男², 国村 利明², 神田 実喜男²

Hidefumi YAGI¹, Akio NAKAYOSHI¹, Hiroyoshi TAKAHASHI¹, Toshinori TAMURA¹, Takemasa MIDORIKAWA¹, Masayuki ONO¹, Koji SHIMIZU¹, Kazuo KIMURA¹, Kentarou NARIHARA¹, Toshio MOROHOSHI², Toshiaki KUNIMURA², Mikio KANDA²

¹昭和大学藤が丘病院外科, ²昭和大学医学部第一病理学教室

¹Department of Surgery, Showa University Fujigaoka Hospital, ²The First Department of Pathology, Showa University

キーワード : Layer structure of the gallbladder wall, Cholecystitis Gallbladder cancer, Ultrasonography

It is important to compare the layer structure in an ultrasonic image with histopathological findings of the gallbladder wall to diagnose the quality of hypertrophic lesions in the gallbladder wall and to understand the depth of gallbladder cancer. The layer structure in an ultrasonic image of the gallbladder wall generally falls into five categories: 1 layer/higher echo, 1 layer/comparable or lower echo, 2 layers, 3 layers, and 4 or morelayers. Of these, lesions which ultrasonographically show 1 layer/comparable or lower echo or a 2-layer structure and irregularity in the layer structure and in the inner surface of the gallbladder should be suspected of cancer. Histologically, some lesions of the abscess or granuloma type show an ultrasonic image similar to that of cancer, and require differentiation from cancer.
In the 3-layer structure of chronic cholecystitis, the second layer is considered to be related to fibrosis of the tunica propria muscularis and the connecting tunica subserosa, which is difficult to differentiate from cancer in evaluating the depth of cancer.