山本 明広¹, 江口 孝行¹, 尾関 孝二², 西田 啓子², 田中 淳子², 井上 智恵子², 門田 尚³

Akihiro YAMAMOTO¹, Takayuki EGUCHI¹, Koji OZEKI², Keiko NISHIDA², Junko TANAKA², Chieko INOUE², Hisashi MONDEN³

¹水島協同病院外科, ²水島協同病院臨床検査部, ³水島協同病院病理部

¹Department of Surgery, Mizushima Kyodo Hospital, ²Department of Laboratory Medicine, Mizushima Kyodo Hospital, ³Department of Pathology, Mizushima Kyodo Hospital

キーワード : Cavernous lymphangioma, Gallbladder, Ultrasonography

Lymphangiomas arising in the abdominal cavity are uncommon, and among them, those of the gallbladder are extremely rare. We could find only one report of the sonographic appearance of this entity. Here we present a second instance of sonographic detection of this rare angiomatous lesion. A 74-year-old man came to this instituion because of anorexia and sustained diarrhea. Sonographic examination of the gallbladder showed a multilocular smooth-surfaced mass bulging in the lumen, and non-echoic, 'uncomplicated' fluid in the variously sized locules, the comet-tail sign, which usually appears in cases of adenomyosis, was lacking, however. Endoscopic retrograde cholecystography showed a normal-sized well-opacified gallbladder partly occupied by a smooth-contoured radiolucent mass that corresponded to the sonographic appearance of the tumor. The gross appearance of the resected specimen showed a relatively well-defined, slightly compressible tumor in the wall. Many fluid-filled loculi of varying size had replaced almost the entire thickness of the cut section of the wall. Microscopy showed this to be a benign vascular lesion consisting of irregularly ramifying vascular channels with a flattened endothelial lining and occasionally with incomplete external sheaths of smooth muscle in the wall. These finings were compatible with cavernous hemangioma or, more accurately, lymphangiomatoid developmental anomaly. This entity is so rare in the gallbladder that it is often difficult to establish an unequivocal preoperative diagnosis. Careful sonographic examination is the imagining modality of choice, however, and can be helpful in indicating the correct diagnosis.