急激な転帰を辿ったGranulocyte colony stimulating factor（G-CSF）産生肝内胆管癌の1例
症例は76歳，女性．2週間続く心窩部痛を主訴に受診した．造影CTにて肝右葉に辺縁主体に造影される巨大不整形腫瘍を認め，肝内胆管癌と診断した．肝門部から傍大動脈領域には腫大リンパ節が散見され，肺野には小結節が多発し転移を疑った．白血球数は37800 /μlと著しい高値を示し，血清Granulocyte colony stimulating factor（G-CSF）値上昇，組織診で抗G-CSF抗体免疫染色陽性よりG-CSF産生腫瘍と診断した．化学療法を予定したが急激に病勢は進行し，約1カ月後に死亡した．G-CSF産生腫瘍は肺癌での報告が多く，肝内胆管癌での報告は稀である．また，G-CSF産生腫瘍...
Saved in:
| Published in | Tando Vol. 29; no. 1; pp. 138 - 144 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本胆道学会
2015
Japan Biliary Association 一般社団法人 日本胆道学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-0077 1883-6879 |
| DOI | 10.11210/tando.29.138 |
Cover
| Abstract | 症例は76歳，女性．2週間続く心窩部痛を主訴に受診した．造影CTにて肝右葉に辺縁主体に造影される巨大不整形腫瘍を認め，肝内胆管癌と診断した．肝門部から傍大動脈領域には腫大リンパ節が散見され，肺野には小結節が多発し転移を疑った．白血球数は37800 /μlと著しい高値を示し，血清Granulocyte colony stimulating factor（G-CSF）値上昇，組織診で抗G-CSF抗体免疫染色陽性よりG-CSF産生腫瘍と診断した．化学療法を予定したが急激に病勢は進行し，約1カ月後に死亡した．G-CSF産生腫瘍は肺癌での報告が多く，肝内胆管癌での報告は稀である．また，G-CSF産生腫瘍は悪性度が高く，進行が極めて早いものが多い．著明な白血球，炎症反応の上昇を認める悪性腫瘍症例において，感染症や血液疾患などの影響が否定的な場合にはG-CSF産生腫瘍を疑い，迅速に診断し，治療を行う必要がある． |
|---|---|
| AbstractList | 症例は76歳，女性．2週間続く心窩部痛を主訴に受診した．造影CTにて肝右葉に辺縁主体に造影される巨大不整形腫瘍を認め，肝内胆管癌と診断した．肝門部から傍大動脈領域には腫大リンパ節が散見され，肺野には小結節が多発し転移を疑った．白血球数は37800 /μlと著しい高値を示し，血清Granulocyte colony stimulating factor（G-CSF）値上昇，組織診で抗G-CSF抗体免疫染色陽性よりG-CSF産生腫瘍と診断した．化学療法を予定したが急激に病勢は進行し，約1カ月後に死亡した．G-CSF産生腫瘍は肺癌での報告が多く，肝内胆管癌での報告は稀である．また，G-CSF産生腫瘍は悪性度が高く，進行が極めて早いものが多い．著明な白血球，炎症反応の上昇を認める悪性腫瘍症例において，感染症や血液疾患などの影響が否定的な場合にはG-CSF産生腫瘍を疑い，迅速に診断し，治療を行う必要がある． A 76-year-old woman was referred to our hospital due to upper abdominal pain and liver tumor. A computed tomography scan revealed a huge tumor in the right lobe of liver, swelling abdominal lymph node and multiple lung nodule. Biopsy specimen of liver tumor confirmed that she had cholangiocellular carcinoma. Immunohistochemical staining of the biopsy specimen with anti granulocyte colony stimulating factor (G-CSF) antibody was positive, and white blood cell count and serum G-CSF level was very high. These facts supported that this carcinoma was producing G-CSF. Since the rapid progression of the tumor suddenly aggravated her general condition, she died after a month. G-CSF producing intrahepatic cholangiocarcinoma is extremely rare, however, we should keep in mind that the tumor grows very fast. Therefore, in suspected case of G-CSF producing tumor, we should proceed the diagnosis and treatment as soon as possible. 症例は76歳，女性．2週間続く心窩部痛を主訴に受診した．造影CTにて肝右葉に辺縁主体に造影される巨大不整形腫瘍を認め，肝内胆管癌と診断した．肝門部から傍大動脈領域には腫大リンパ節が散見され，肺野には小結節が多発し転移を疑った．白血球数は37800 /μlと著しい高値を示し，血清Granulocyte colony stimulating factor（G-CSF）値上昇，組織診で抗G-CSF抗体免疫染色陽性よりG-CSF産生腫瘍と診断した．化学療法を予定したが急激に病勢は進行し，約1カ月後に死亡した．G-CSF産生腫瘍は肺癌での報告が多く，肝内胆管癌での報告は稀である．また，G-CSF産生腫瘍は悪性度が高く，進行が極めて早いものが多い．著明な白血球，炎症反応の上昇を認める悪性腫瘍症例において，感染症や血液疾患などの影響が否定的な場合にはG-CSF産生腫瘍を疑い，迅速に診断し，治療を行う必要がある． |
| Author | 西江, 裕忠 井上, 匡央 水島, 隆史 奥村, 文浩 西, 祐二 安部, 快紀 佐野, 仁 |
| Author_FL | Sano Hitoshi Okumura Fumihiro Inoue Tadahisa Nishie Hirotada Nishi Yuji Mizushima Takashi Anbe Kaiki |
| Author_FL_xml | – sequence: 1 fullname: Inoue Tadahisa – sequence: 2 fullname: Okumura Fumihiro – sequence: 3 fullname: Mizushima Takashi – sequence: 4 fullname: Nishi Yuji – sequence: 5 fullname: Nishie Hirotada – sequence: 6 fullname: Anbe Kaiki – sequence: 7 fullname: Sano Hitoshi |
| Author_xml | – sequence: 1 fullname: 西江, 裕忠 organization: 岐阜県立多治見病院消化器内科 – sequence: 1 fullname: 奥村, 文浩 organization: 岐阜県立多治見病院消化器内科 – sequence: 1 fullname: 安部, 快紀 organization: 岐阜県立多治見病院消化器内科 – sequence: 1 fullname: 佐野, 仁 organization: 岐阜県立多治見病院消化器内科 – sequence: 1 fullname: 井上, 匡央 organization: 岐阜県立多治見病院消化器内科 – sequence: 1 fullname: 水島, 隆史 organization: 岐阜県立多治見病院消化器内科 – sequence: 1 fullname: 西, 祐二 organization: 岐阜県立多治見病院消化器内科 |
| BackLink | https://cir.nii.ac.jp/crid/1390001204349179008$$DView record in CiNii |
| BookMark | eNo9kL9PwkAcxS8GExEZ3Rlci3e9o72bjCGCJiQO6tx8aa9YUlrTloENMBKNTobFwRAlLg7E0UQCf0zlx8a_IIJxeS8v75M3vG2U8HxPIrRLcJYQleD9CDzLz6oiSyjfQEnCOVU0rosESmJBmIKxrm-hdBg6ZZzjTDDGaRJVps236bgZt97nX6-Tz4-4_TgfjeNWP271igF4ddc3G5HMmL7re41MGDm1uguR41UyNpiRHyyGt0Ulf1ZYDO9m3f6s25u3nyedm_l1ZzZ4mT09xK0B-R7d76BNG9xQpv88hS4KR-f5Y6V0WjzJH5aUqoo5VzTGpVbmXNctEAxbkgBVicaxpdtSYya1hVCxzWwNJAUoY05VzDQuJANgOYum0N5613Mcw3R-lVCBMSZLjjJB9GXgS-xgjVXDCCrSuAqcGgQNA4LIMV1prM40VGGQlVD-35iXEBhVoD_nnYWe |
| ContentType | Journal Article |
| Copyright | 2015 日本胆道学会 |
| Copyright_xml | – notice: 2015 日本胆道学会 |
| DBID | RYH |
| DOI | 10.11210/tando.29.138 |
| DatabaseName | CiNii Complete |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| Discipline | Medicine |
| DocumentTitleAlternate | A case of granulocyte colony stimulating factor producing Intrahepatic cholangiocarcinoma |
| DocumentTitle_FL | A case of granulocyte colony stimulating factor producing Intrahepatic cholangiocarcinoma |
| EISSN | 1883-6879 |
| EndPage | 144 |
| ExternalDocumentID | 130005067669 article_tando_29_1_29_138_article_char_ja |
| GroupedDBID | .LE ALMA_UNASSIGNED_HOLDINGS KQ8 MOJWN RJT RYH |
| ID | FETCH-LOGICAL-j2088-648e6b8877da940de1a321680d7fe64c3f9920f4f6ae3aab083204689e4aa45d3 |
| ISSN | 0914-0077 |
| IngestDate | Thu Jun 26 22:27:42 EDT 2025 Wed Sep 03 06:29:21 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | false |
| IsScholarly | true |
| Issue | 1 |
| Language | Japanese |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-j2088-648e6b8877da940de1a321680d7fe64c3f9920f4f6ae3aab083204689e4aa45d3 |
| OpenAccessLink | https://www.jstage.jst.go.jp/article/tando/29/1/29_138/_article/-char/ja |
| PageCount | 7 |
| ParticipantIDs | nii_cinii_1390001204349179008 jstage_primary_article_tando_29_1_29_138_article_char_ja |
| PublicationCentury | 2000 |
| PublicationDate | 2015 |
| PublicationDateYYYYMMDD | 2015-01-01 |
| PublicationDate_xml | – year: 2015 text: 2015 |
| PublicationDecade | 2010 |
| PublicationTitle | Tando |
| PublicationTitleAlternate | 胆道 |
| PublicationTitle_FL | Journal of Japan Biliary Association J.J.B.A 胆道 |
| PublicationYear | 2015 |
| Publisher | 日本胆道学会 Japan Biliary Association 一般社団法人 日本胆道学会 |
| Publisher_xml | – name: 日本胆道学会 – name: Japan Biliary Association – name: 一般社団法人 日本胆道学会 |
| References | 2) 北川誠一. CSF産生腫瘍. 日本臨牀 (別冊) 血液症候群II. 1998: 25-27 11) 猪狩洋介, 石田 哲, 磐田 郁, ほか. 白血球増多を伴った胆管細胞癌の1例. 福岡大医紀 2008; 35: 41-45 1) Morstyn G, Burgess AW. Hemopietic growth factors: a review. Cancer Res 1988; 48: 5624-5637 22) Savarese TM, Mitchell K, McQuain C, et al. Coexpression of granulocyte colony-stimulating factor and its receptor in primary ovarian carcinomas. Cancer Lett 2001; 162: 105-115 7) 増田淳一, 大曲勝久, 野元健行, ほか. G-CSF産生肝内胆管癌の1剖検例. 日消誌 2000; 97: 347-352 13) Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J 1990; 265: 621-636 18) 水口真二郎, 井上清俊, 岩田 隆, ほか. 関節炎症状を伴ったG-CSF産生肺腺癌の一切除例. 日呼外会誌 2005; 19: 117-121 15) Murata Y, Kubota K, Yukihiro M, et al. Correlations between 18F-FDG up take by bone marrow and hematological parameters: measurements by PET/CT. Nucl Med Biol 2006; 33: 999-1004 5) 玉井 修, 松本光之, 中本 尊, ほか. 血清Granulocyte colony-stimulating factorが高値を呈し白血球増多を来たした肝内胆管癌の1例. 日消外会誌 1995; 28: 1100-1104 6) Aizawa M, Koshiyama H, Inoue D, et al. Postoperative aggravation of hypercalcemia-leukocytosis syndrome in a case of squamous cell type cholangiocarcinoma. Intern Med 1997; 36: 232 17) 小倉 健, 瀧井道明, 有坂好史, ほか. 特徴的なFDG-PET所見を呈したG-CSF産生胆嚢腺扁平上皮癌の1剖検例. 胆道 2011; 25: 759-767 4) 山本哲彰, 鶴岡祥子, 山内健介, ほか. 肺転移巣からG-CSF産生を認めた下顎歯肉扁平上皮癌の1例. 口腔腫瘍 2013; 25: 13-19 20) Oshika Y, Nakamura M, Hatanaka H, et al. A human lung cancer xenograft producing granulocyte-colony stimulating factor and parathyroid hormone-related protein. Oncol Reports 1998; 5: 359-362 12) 下村 治, 福永 潔, 中野順隆, ほか. 肝切除後極めて急激な再発を認めた肉腫様変化を伴うG-CSF産生肝内胆管癌の1例. 日消外会誌 2013; 46: 41-49 8) 柿木嘉平太, 竹森康弘, 野田八嗣, ほか. G-CSF産生肝内胆管癌の1剖検例. 日消誌 2000; 97: 1165-1169 10) Sohda T, Shiga H, Nakane H, et al. Cholangiocellular carcinoma that produced both granulocyte-colony-stimulating factor and parathyroid hormone-related protein. Int J Clin Oncol 2006; 11: 246-249 14) Sugawara Y, Fisher SJ, Zasadny KR, et al. Preclinical and clinical studies of bone marrow uptake of fluorine-1-fluorodeoxyglucose with or without granulocyte colony-stimulating factor during chemotherapy. J Clin Oncol 1998; 16: 173-180 16) Morooka M, Kubota K, Murata Y, et al. 18F-FDG-PET/CT findings of granulocyte colony stimulating factor (G-CSF) -producing lung tumors. Ann Nucl Med 2008; 22: 635-639 21) Tachibana M, Miyakawa A, Tazaki H, et al. Autocrine growth of transitional cell carcinoma of the bladder induced by granulocyte-colony-stimulating factor. Cancer Res 1995; 55: 3438-3443 9) Shinojima Y, Toma Y, Terui T. Sweet syndrome associated with intrahepatic cholangiocarcinoma producing granulocyte colony-stimulating factor. Br J Dermatol 2006; 155: 1103-1104 19) 吉原好治郎, 福山邦昭, 岡村 孝, ほか. CSF (colony-stimulating factor) 産生肺癌の一剖検例と文献的考察. 癌の臨 1986; 32: 805-809 3) Asano S, Urabe A, Obabe T, et al. Demonstration of Granulopoietic Factor (s) in the plasma of nude mice transplanted with a human lung cancer and in the tumor tissue. Blood 1977; 49: 845-852 |
| References_xml | – reference: 12) 下村 治, 福永 潔, 中野順隆, ほか. 肝切除後極めて急激な再発を認めた肉腫様変化を伴うG-CSF産生肝内胆管癌の1例. 日消外会誌 2013; 46: 41-49 – reference: 7) 増田淳一, 大曲勝久, 野元健行, ほか. G-CSF産生肝内胆管癌の1剖検例. 日消誌 2000; 97: 347-352 – reference: 15) Murata Y, Kubota K, Yukihiro M, et al. Correlations between 18F-FDG up take by bone marrow and hematological parameters: measurements by PET/CT. Nucl Med Biol 2006; 33: 999-1004 – reference: 5) 玉井 修, 松本光之, 中本 尊, ほか. 血清Granulocyte colony-stimulating factorが高値を呈し白血球増多を来たした肝内胆管癌の1例. 日消外会誌 1995; 28: 1100-1104 – reference: 16) Morooka M, Kubota K, Murata Y, et al. 18F-FDG-PET/CT findings of granulocyte colony stimulating factor (G-CSF) -producing lung tumors. Ann Nucl Med 2008; 22: 635-639 – reference: 6) Aizawa M, Koshiyama H, Inoue D, et al. Postoperative aggravation of hypercalcemia-leukocytosis syndrome in a case of squamous cell type cholangiocarcinoma. Intern Med 1997; 36: 232 – reference: 1) Morstyn G, Burgess AW. Hemopietic growth factors: a review. Cancer Res 1988; 48: 5624-5637 – reference: 4) 山本哲彰, 鶴岡祥子, 山内健介, ほか. 肺転移巣からG-CSF産生を認めた下顎歯肉扁平上皮癌の1例. 口腔腫瘍 2013; 25: 13-19 – reference: 18) 水口真二郎, 井上清俊, 岩田 隆, ほか. 関節炎症状を伴ったG-CSF産生肺腺癌の一切除例. 日呼外会誌 2005; 19: 117-121 – reference: 3) Asano S, Urabe A, Obabe T, et al. Demonstration of Granulopoietic Factor (s) in the plasma of nude mice transplanted with a human lung cancer and in the tumor tissue. Blood 1977; 49: 845-852 – reference: 19) 吉原好治郎, 福山邦昭, 岡村 孝, ほか. CSF (colony-stimulating factor) 産生肺癌の一剖検例と文献的考察. 癌の臨 1986; 32: 805-809 – reference: 2) 北川誠一. CSF産生腫瘍. 日本臨牀 (別冊) 血液症候群II. 1998: 25-27 – reference: 22) Savarese TM, Mitchell K, McQuain C, et al. Coexpression of granulocyte colony-stimulating factor and its receptor in primary ovarian carcinomas. Cancer Lett 2001; 162: 105-115 – reference: 13) Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J 1990; 265: 621-636 – reference: 21) Tachibana M, Miyakawa A, Tazaki H, et al. Autocrine growth of transitional cell carcinoma of the bladder induced by granulocyte-colony-stimulating factor. Cancer Res 1995; 55: 3438-3443 – reference: 11) 猪狩洋介, 石田 哲, 磐田 郁, ほか. 白血球増多を伴った胆管細胞癌の1例. 福岡大医紀 2008; 35: 41-45 – reference: 8) 柿木嘉平太, 竹森康弘, 野田八嗣, ほか. G-CSF産生肝内胆管癌の1剖検例. 日消誌 2000; 97: 1165-1169 – reference: 9) Shinojima Y, Toma Y, Terui T. Sweet syndrome associated with intrahepatic cholangiocarcinoma producing granulocyte colony-stimulating factor. Br J Dermatol 2006; 155: 1103-1104 – reference: 14) Sugawara Y, Fisher SJ, Zasadny KR, et al. Preclinical and clinical studies of bone marrow uptake of fluorine-1-fluorodeoxyglucose with or without granulocyte colony-stimulating factor during chemotherapy. J Clin Oncol 1998; 16: 173-180 – reference: 10) Sohda T, Shiga H, Nakane H, et al. Cholangiocellular carcinoma that produced both granulocyte-colony-stimulating factor and parathyroid hormone-related protein. Int J Clin Oncol 2006; 11: 246-249 – reference: 20) Oshika Y, Nakamura M, Hatanaka H, et al. A human lung cancer xenograft producing granulocyte-colony stimulating factor and parathyroid hormone-related protein. Oncol Reports 1998; 5: 359-362 – reference: 17) 小倉 健, 瀧井道明, 有坂好史, ほか. 特徴的なFDG-PET所見を呈したG-CSF産生胆嚢腺扁平上皮癌の1剖検例. 胆道 2011; 25: 759-767 |
| SSID | ssib058494483 ssj0067390 ssib002671037 ssib002004169 ssib053391720 ssib002670270 ssib003171127 |
| Score | 2.0041964 |
| Snippet | 症例は76歳，女性．2週間続く心窩部痛を主訴に受診した．造影CTにて肝右葉に辺縁主体に造影される巨大不整形腫瘍を認め，肝内胆管癌と診断した．肝門部から傍大動脈領... A 76-year-old woman was referred to our hospital due to upper abdominal pain and liver tumor. A computed tomography scan revealed a huge tumor in the right... |
| SourceID | nii jstage |
| SourceType | Publisher |
| StartPage | 138 |
| SubjectTerms | cholangiocarcinoma G-CSF granulocyte colony stimulating factor 肝内胆管癌 顆粒球コロニー刺激因子 |
| Title | 急激な転帰を辿ったGranulocyte colony stimulating factor（G-CSF）産生肝内胆管癌の1例 |
| URI | https://www.jstage.jst.go.jp/article/tando/29/1/29_138/_article/-char/ja https://cir.nii.ac.jp/crid/1390001204349179008 |
| Volume | 29 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | 胆道, 2015/03/31, Vol.29(1), pp.138-144 |
| journalDatabaseRights | – providerCode: PRVAFT databaseName: Open Access Digital Library customDbUrl: eissn: 1883-6879 dateEnd: 99991231 omitProxy: true ssIdentifier: ssj0067390 issn: 0914-0077 databaseCode: KQ8 dateStart: 19870101 isFulltext: true titleUrlDefault: http://grweb.coalliance.org/oadl/oadl.html providerName: Colorado Alliance of Research Libraries |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnR1NaxNBdGkriBfxE6tWcnBOYcvuzuzszEXYjbstgoLYQm_LJNlIQk1E0kM9NRWLoifpxYMULV48FI-Cpf0xsU1u_Qu-N7NJ1g_w4zK8nXmZeftm37yPzLyxrJu-ErVMBJntNphjY0IuW7i1hu0qj6lqgzWyTGf7vMcXl9mdFX9lavpWYdfSWrc6X3v623Ml_zOrUAfziqdk_2Fmx51CBcAwv1DCDEP5V3NMYo47FUIfgShBOKZgG5IwJLEgUURCj8Q-iQA2TR6Rnm6KET9HpjkgkwXQXGug3ta7uIl9tdNeL8MS8Ehf8YU7LvXlPCROSFQhQizYlQfJ6EmSOCCS6d40IBMcCEe8jTQIINXXNRRhwAljEroaWRJRGRETQxVD-kRUNJyXVLveGX0dGiMk0tcAdBmW9RAV3aFPQiAjniD7yCHDJKBFumUNAT2B5hu0yQkyR1ZFTLONkogDsiQy1DTDEPCy3gRZYLdRUtav4xPp5JSJSjGaYk6SGh0Htkm7HDVXm7hb8WfZyEOmLrMx_5HRnUZhCEFtLsyFOCONksdwipJj1INrMtnkloZrMl_-qsTADYdPD0NJnXlPzo9_9UNecPwf0vHB2OBcTlunPIxH4aaE-wX3EbOp8WI6ucDxCuszPOMx0cL6HsDg42fwBMCZn7gTYKtK8ObHlg4PqIlhjvgyymGLx8KK1IN11wJfB5NYTLebzYIBt3TOOpt7XqXQiNF5a6qlLlin7-Z7Sy5aD483Ph4fbvR7n4ZfPxx9-dzffDM8OOz3dvu9nYJclIxclApyUTJycbL_QkvEyf7LwfbuYHtnuPnuaOv58NnWYO_94O3rfm_P_Xbw6pK1nMRLlUU7v4bEbnmgg23ORMaroIyDupLMqWeuop7LhVMPGhlnNdqQ0nNgWeMqo0pVwanxHMaFzJhSzK_Ty9ZMu9POrlglDGPjRZ5MsRpruFJkNEOfDLqUNRHQWUsYRqWPTa6ZNF9bUs3O1JOpqwsqxi14OjNtqVlrDlibAsegBLdOh5gdRpnEHHyOuPqH9mvWGZQHE128bs10n6xlc2Bvd6s39Ef1HUIWs4A |
| linkProvider | Colorado Alliance of Research Libraries |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E6%80%A5%E6%BF%80%E3%81%AA%E8%BB%A2%E5%B8%B0%E3%82%92%E8%BE%BF%E3%81%A3%E3%81%9FGranulocyte+colony+stimulating+factor%EF%BC%88G-CSF%EF%BC%89%E7%94%A3%E7%94%9F%E8%82%9D%E5%86%85%E8%83%86%E7%AE%A1%E7%99%8C%E3%81%AE1%E4%BE%8B&rft.jtitle=Tando&rft.au=%E4%BA%95%E4%B8%8A+%E5%8C%A1%E5%A4%AE&rft.au=%E5%A5%A5%E6%9D%91+%E6%96%87%E6%B5%A9&rft.au=%E6%B0%B4%E5%B3%B6+%E9%9A%86%E5%8F%B2&rft.au=%E8%A5%BF+%E7%A5%90%E4%BA%8C&rft.date=2015&rft.pub=Japan+Biliary+Association&rft.issn=0914-0077&rft.eissn=1883-6879&rft.volume=29&rft.issue=1&rft.spage=138&rft.epage=144&rft_id=info:doi/10.11210%2Ftando.29.138&rft.externalDocID=130005067669 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0914-0077&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0914-0077&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0914-0077&client=summon |