び漫性に胆管および胆嚢壁肥厚像を呈したNivolumab関連胆管炎の1例

症例は81歳の女性.肺癌に対しNivolumab投与中に肝胆道系酵素上昇と腹部エコーで胆嚢壁肥厚を認め精査目的に当科紹介された.造影CTではび漫性に胆管および胆嚢に濃染する壁肥厚所見を認めたが胆嚢の緊満感はなく,肝内胆管拡張も認めなかった.EUSでは胆管および胆嚢のび漫性壁肥厚所見を認めたが狭窄所見は認めなかった.ERCP胆管像も狭窄所見は認めず,endoscopic nasobiliary drainage tube留置も肝胆道系酵素は改善しなかった.肝生検および胆管生検の病理所見では胆管上皮に好中球浸潤が目立っていたが,悪性所見は認めなかった.Nivolumabによる免疫関連性有害事象と判...

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Published inTando Vol. 32; no. 1; pp. 132 - 138
Main Authors 佐藤, 辰宣, 遠藤, 伸也, 寺田, 修三, 室, 博之, 榎田, 浩平, 川口, 真矢, 白根, 尚文
Format Journal Article
LanguageJapanese
Published 日本胆道学会 2018
Japan Biliary Association
Subjects
Online AccessGet full text
ISSN0914-0077
1883-6879
DOI10.11210/tando.32.132

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Abstract 症例は81歳の女性.肺癌に対しNivolumab投与中に肝胆道系酵素上昇と腹部エコーで胆嚢壁肥厚を認め精査目的に当科紹介された.造影CTではび漫性に胆管および胆嚢に濃染する壁肥厚所見を認めたが胆嚢の緊満感はなく,肝内胆管拡張も認めなかった.EUSでは胆管および胆嚢のび漫性壁肥厚所見を認めたが狭窄所見は認めなかった.ERCP胆管像も狭窄所見は認めず,endoscopic nasobiliary drainage tube留置も肝胆道系酵素は改善しなかった.肝生検および胆管生検の病理所見では胆管上皮に好中球浸潤が目立っていたが,悪性所見は認めなかった.Nivolumabによる免疫関連性有害事象と判断しステロイドを投与し,肝胆道系酵素の改善および胆管と胆嚢壁肥厚所見の改善を認めた.Nivolumab関連胆管炎の特徴的な画像所見を呈した1例と考えられた.
AbstractList 要旨 : 症例は81歳の女性. 肺癌に対しNivolumab投与中に肝胆道系酵素上昇と腹部エコーで胆嚢壁肥厚を認め精査目的に当科紹介された. 造影CTではび漫性に胆管および胆嚢に濃染する壁肥厚所見を認めたが胆嚢の緊満感はなく, 肝内胆管拡張も認めなかった. EUSでは胆管および胆嚢のび漫性壁肥厚所見を認めたが狭窄所見は認めなかった. ERCP胆管像も狭窄所見は認めず, endoscopic nasobiliary drainage tube留置も肝胆道系酵素は改善しなかった. 肝生検および胆管生検の病理所見では胆管上皮に好中球浸潤が目立っていたが, 悪性所見は認めなかった. Nivolumabによる免疫関連性有害事象と判断しステロイドを投与し, 肝胆道系酵素の改善および胆管と胆嚢壁肥厚所見の改善を認めた. Nivolumab関連胆管炎の特徴的な画像所見を呈した1例と考えられた.
An 81-year-old woman, who was treated with nivolumab monotherapy, was referred to our department because of high levels of biliary tract enzymes, detected on performing a blood test. Computed tomography and endoscopic ultrasound showed diffuse wall thickening of the bile duct and gallbladder. Endoscopic retrograde cholangiography revealed extrahepatic bile duct dilation without obstruction. Nivolumab-induced cholangitis was diagnosed and she received steroid therapy. After steroid therapy, both the levels of biliary tract enzymes in blood and the diffuse wall thickening of the bile duct and gallbladder decreased. 症例は81歳の女性.肺癌に対しNivolumab投与中に肝胆道系酵素上昇と腹部エコーで胆嚢壁肥厚を認め精査目的に当科紹介された.造影CTではび漫性に胆管および胆嚢に濃染する壁肥厚所見を認めたが胆嚢の緊満感はなく,肝内胆管拡張も認めなかった.EUSでは胆管および胆嚢のび漫性壁肥厚所見を認めたが狭窄所見は認めなかった.ERCP胆管像も狭窄所見は認めず,endoscopic nasobiliary drainage tube留置も肝胆道系酵素は改善しなかった.肝生検および胆管生検の病理所見では胆管上皮に好中球浸潤が目立っていたが,悪性所見は認めなかった.Nivolumabによる免疫関連性有害事象と判断しステロイドを投与し,肝胆道系酵素の改善および胆管と胆嚢壁肥厚所見の改善を認めた.Nivolumab関連胆管炎の特徴的な画像所見を呈した1例と考えられた.
症例は81歳の女性.肺癌に対しNivolumab投与中に肝胆道系酵素上昇と腹部エコーで胆嚢壁肥厚を認め精査目的に当科紹介された.造影CTではび漫性に胆管および胆嚢に濃染する壁肥厚所見を認めたが胆嚢の緊満感はなく,肝内胆管拡張も認めなかった.EUSでは胆管および胆嚢のび漫性壁肥厚所見を認めたが狭窄所見は認めなかった.ERCP胆管像も狭窄所見は認めず,endoscopic nasobiliary drainage tube留置も肝胆道系酵素は改善しなかった.肝生検および胆管生検の病理所見では胆管上皮に好中球浸潤が目立っていたが,悪性所見は認めなかった.Nivolumabによる免疫関連性有害事象と判断しステロイドを投与し,肝胆道系酵素の改善および胆管と胆嚢壁肥厚所見の改善を認めた.Nivolumab関連胆管炎の特徴的な画像所見を呈した1例と考えられた.
Author 遠藤, 伸也
寺田, 修三
室, 博之
白根, 尚文
川口, 真矢
榎田, 浩平
佐藤, 辰宣
Author_FL Satoh Tatsunori
Terada Shuzo
Muro Hiroyuki
Endo Shinya
Shirane Naofumi
Kawaguchi Shinya
Enokida Kohei
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  fullname: Terada Shuzo
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  fullname: Shirane Naofumi
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  fullname: Muro Hiroyuki
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References 4) 小野薬品工業. オプジーボ インタビューフォーム. http://www.opdivo.jp/contents/pdf/open/interview.pdf
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– reference: 8) Kawakami H, Tanizaki J, Tanaka K, et al. Imaging and clinicopathological features of nivolumab-related cholangitis in patients with non-small cell lung cancer. Invest New Drugs 2017. DOI: 10.1007/s10637-017-0453-0
– reference: 7) Spain L, Diem S, Larkin J. Management of toxicities of immune checkpoint inhibitors. Cancer Treat Rev 2016; 44: 51-60
– reference: 5) Friedman CF, Proverbs-Singh TA, Postow MA. Treatment of the Immune-Related Adverse Effects of Immune Checkpoint Inhibitors: A Review. JAMA Oncol 2016; 2: 1346-1353
– reference: 2) 爲政大幾. ニボルマブ-効果と安全性について-. 皮膚臨床 2015; 57: 1647-1653
– reference: 3) Topalian SL, Hodi FS, Brahmer JR, et al. Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med 2012; 366: 2443-2454
– reference: 9) Gelsomino F, Vitale G, D'Errico A, et al. Nivolumab-induced cholangitic liver disease: a novel form of serious liver injury. Ann Oncol 2017; 28: 671-672
– reference: 6) Villadolid J, Amin A. Immune checkpoint inhibitors in clinical practice: update on management of immune-related toxicities. Transl Lung Canser Res 2015; 4: 560-575
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Snippet 症例は81歳の女性.肺癌に対しNivolumab投与中に肝胆道系酵素上昇と腹部エコーで胆嚢壁肥厚を認め精査目的に当科紹介された.造影CTではび漫性に胆管および胆嚢に濃染する...
要旨 : 症例は81歳の女性. 肺癌に対しNivolumab投与中に肝胆道系酵素上昇と腹部エコーで胆嚢壁肥厚を認め精査目的に当科紹介された. 造影CTではび漫性に胆管および胆嚢に...
An 81-year-old woman, who was treated with nivolumab monotherapy, was referred to our department because of high levels of biliary tract enzymes, detected on...
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jstage
SourceType Publisher
StartPage 132
SubjectTerms cholangitis
cholecystitis
immune-related adverse events
Nivolumab
胆嚢炎
胆管炎
Title び漫性に胆管および胆嚢壁肥厚像を呈したNivolumab関連胆管炎の1例
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