key word ：胆嚢内高吸収域、胆嚢高吸収域、胆嚢壁高吸収域、石灰乳胆汁、造影剤残存、胆石症、胆嚢内出血、胆泥、デブリス、スラッジ、スラッジボール、胆嚢癌、磁気様胆嚢、high density in gallbladder, milk of calcium of bile, residual contrast media in GB, gallstone, hemorrhage in GB, debris, sludge, sludge ball, gallbladder carcinoma, porcelain gallbladder
文献：
Itoh H. Management of limy bile syndrome: no therapy, laparotomy or endoscopic treatment?Intern Med. 2003 Jan;42:1-2
Takatori Y, et al. Limy bile syndrome complicated with primary hyperparathyroidism. Intern Med. 2003 Jan;42:44-7.
Hopper KD, et al. Vicarious excretion of water-soluble contrast media into the gallbladder in patients with normal serum creatinine. Invest Radiol. 1988 ;23:604-8.
Ford KK, Wysong B, Thompson WM. Opacification of the gallbladder following intravenous contrast injection in patients with normal renal function. Urol Radiol. 1983;5:251-2.
Yamazaki H, et al. CT assessment of gallbladder opacification 12-24 hours after angiography. Nippon Igaku Hoshasen Gakkai Zasshi. 1992;52:1281-1286
Yamazaki H, et al. Lack of correlation between gallbladder opacification in delayed CT and contrast-associated nephropathy. Eur Radiol. 1997;7:1328-31.
Pandya R, O’Malley C. Hemorrhagic cholecystitis as a complication of anticoagulant therapy: role of CT in its diagnosis. Abdom Imaging. 2008; 33:652-3
Watanabe Y, et al. MR imaging of acute biliary disorders. Radiographics. 2007; 27:477-495
Kane RA, Jacobs R, Katz J, Costello P. Porcelain gallbladder: ultrasound and CT appearance. Radiology. 1984 ;152:137-41.
Towfigh S, McFadden DW, Cortina GR, et al. Porcelain gallbladder is not associated with gallbladder carcinoma.Am Surg. 2001; 67:7-10.
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Key words: 巨大膵腫瘍、進行早い膵癌、膵癌、退形成性癌、膵巨細細胞型、破骨細胞型、Anaplastic carcinoma of pancreas、GCT of pancreas, giant cell carcinoma of osteoclastoid type, Pleomorphic carcinoma
Key images:
退形成性膵癌を疑う時はどんな時？
①初診時に既にかなり進行した膵および膵周囲腫瘤
②膵癌が疑われるが、腫瘍マーカー上昇がない、白血球上昇がある
③巨大な充実性腫瘍で、内部壊死傾向強い
References:
1. Nakajima A, et al. Anaplastic carcinoma of the pancreas producing granulocyte-colony stimulating factor: a case report. J Med Case Reports. 2008;2:391
2. Oyama Y, et al. Relatively rare Osteoclast-type giant cell tumor of the pancreas-resection case. Fukubuhoushasennkenkyukai. 2003;9:126-127
3. Nojima T et al. Pleomorphic carcinoma of the pancreas with osteoclast-like giant cells. Int J Pancreatol. 1993;14275-281
4. Ichikawa T, et al. Atypical exocrine and endocrine pancreatic tumors (anaplastic, small cell, and giant cell types): CT and pathologic features in 14 patients. Abdom Imaging. 2000; 25:409-419 論文リンクはこちら
1. Sano M, Homma T, Hayashi E, et al. Clinicopathological characteristics of anaplastic carcinoma of the pancreas with rhabdoid features. Virchows Arch. 2014 Nov;465(5):531-8. doi: 10.1007/s00428-014-1631-5. Epub 2014 Jul 17. リンクはこちら
2. Jones TS, Jones EL, McManus M, et al. Multifocal anaplasticpancreatic carcinoma requiring neoadjuvant chemotherapy and total pancreatectomy: report of a case. JOP. 2013 May 10;14(3):289-91. doi: 10.6092/1590-8577/1416.
3. Sanada Y, Yoshida K, Itoh M, Okita R, Okada M. Invasive ductal carcinoma of the pancreas showing exophytic growth. Hepatobiliary Pancreat Dis Int. 2009 Feb;8(1):97-102.] 論文リンクはこちら
4. Nakajima A, Takahashi H, Inamori M, et al. Anaplastic carcinoma of the pancreas producing granulocyte-colony stimulating factor: a case report. J Med Case Rep. 2008 Dec 17;2:391. doi: 10.1186/1752-1947-2-391. 論文リンクはこちら
1. Hammond NA, Miller FH, Day K, et al. Imaging features of the less common pancreatic masses. Abdom Imaging. 2013 Jun;38(3):561-72. doi: 10.1007/s00261-012-9922-2. Review. 画像診断という点では 一番最新論文か 論文リンクはこちら
2. Gotohda N, Nakagohri T, Saito N, et al. A case of anaplastic ductal carcinoma of the pancreas with production of granulocyte-colony stimulating factor. Hepatogastroenterology. 2006 Nov-Dec;53(72):957-9.
3. Ichikawa T, Federle MP, Ohba S, et al. Atypical exocrine and endocrine pancreatic tumors (anaplastic, small cell, and giant cell types): CT and pathologic features in 14 patients. Abdom Imaging. 2000 Jul-Aug;25(4):409-19. 上記既に記載済み（重複）
4. Okazaki M, Makino I, Kitagawa H, et al. A case report of anaplastic carcinoma of the pancreas with remarkable intraductal tumor growth into the main pancreatic duct. World J Gastroenterol. 2014 Jan 21;20(3):852-6. doi: 10.3748/wjg.v20.i3.852
5. Zou XP, Yu ZL, Li ZS, Zhou GZ. Clinicopathological features of giant cell carcinoma of thepancreas. Hepatobiliary Pancreat Dis Int. 2004 May;3(2):300-2.
