A CASE OF CARCINOMA OF THE BILIARY SYSTEMS PRODUCING α-FETOPROTEIN

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  • NAKAJIMA Hideo
    The Second Department of Surgery, Tokyo Medical and Dental University
  • HOJO Ikuo
    Department of Surgery, Niigata Prefectural Tookamachi Hospital
  • ISHIDA Hideyuki
    The Second Department of Surgery, Tokyo Medical and Dental University
  • HIGUCHI Tetsurou
    The Second Department of Surgery, Tokyo Medical and Dental University
  • GONDA Tsuyoshi
    The Second Department of Surgery, Tokyo Medical and Dental University
  • MISHIMA Yoshio
    The Second Department of Surgery, Tokyo Medical and Dental University

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  • αフェトプロテインが高値を示した胆道系腫瘍の1例

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Abstract

A 68-year-old woman was admitted to the hospital because of an upper abdominal pain. Ultrasonography and CT-scan revealed a tumor in the gallbladder, obstruction of the common bile duct and remarkable swelling of lymph nodes. Hematological examinations showed obstructive liver dysfunction and a high α-fetoprotein (AFP) level of 503ng/ml. The AFP subfraction analyzed by crossed immunoaffinoelectrophoresis with lentil lectin and concanavalin A was not hepatocellular type. Percutaneous transhepatic cholangiodrainage was attempted, but soon after the inserted tube was dislodged, requiring an emergency surgery. A curative operation was impossible, because metastatic lymph nodes has surrounded the large vessels very tightly. We performed choledochocystectomy and biliojejunal anastomosis for mass reduction and biliary drainage. AFP temporarily decreased after the operation, but it increased gradually till she died of carcinomatosa peritonitis 5 months postoperatively. Histologically the tumor was poorly differentiated adenocarcinoma and a small number of tumor cells at the bile duct were positive for AFP-immunostaining.<br> An analysis of the doubling time of AFP in cancers of the biliary systems seen in the literature indicates the need for the intensive treatment including radical surgery.

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