肝動注化学療法施行後に切除した門脈腫瘍栓合併肝内胆管癌の1例 A Case of Intrahepatic Cholangiocellular Carcinoma with Portal Vein Tumor Thrombus Treated with Surgery after Hepatic Arterial Infusion Chemotherapy

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Abstract

症例は62歳女性で,検診での超音波検査で肝腫瘍を指摘され,当院を受診した.B型・C型肝炎ウィルスマーカーは陰性であり,血清CA19-9値が281.6U/mlに上昇していた.腹部CTで肝左葉の肝内胆管拡張と肝外側区域に境界不明瞭で辺縁が軽度造影される5cm大の腫瘍を認めた.門脈左枝内は腫瘍栓で充満していた.門脈腫瘍栓合併肝内胆管癌あるいは混合型肝癌を考え,5-FUによる肝動注化学療法を先行させた.治療開始後にCA19-9値の低下,肝腫瘍の縮小と門脈腫瘍栓の退縮を認めた.化学療法終了から1か月,後肝拡大左葉切除,肝外胆管切除・胆道再建,リンパ節郭清,門脈再建を施行した.病理組織学的には乳頭状の増殖を示す高分化型腺癌から成る腫瘍であり,門脈腫瘍栓を伴った肝内胆管癌と診断された.術後22か月の現在,再発なく社会復帰している.門脈腫瘍栓合併肝内胆管癌に関する文献的考察を加え報告する.

A 62 year-old woman visited our hospital for further evaluation of a liver tumor detected by abdominal ultrasonography in an annual medical examination. Hepatitis B and C virus markers were negative. Serum CA19-9 level was elevated to 281.6U/ml. Abdominal computed tomography showed an inhomogeneous tumor 5cm in diameter with bile duct dilatation in the left lateral segment of the liver and the presence of tumor thrombus in the left portal vein. The margin of the hepatic tumor was slightly enhanced in the arterial phase. Intrahepatic cholangiocellular carcinoma or combined hepatocellular and cholangiocarcinoma accompanied by tumor thrombus extending from the left portal vein to the bifurcation of the portal vein was highly suspected. Hepatic arterial infusion chemotherapy (HAIC) by weekly high dose administration of 5-FU (1,000mg/one time) was performed 10 times, prior to the surgery. The hepatic tumor was reduced to 3cm in size with portal tumor thrombus regression. Extended left hepatectomy with biliary tract reconstruction, lymph node dissection, and portal vein reconstruction was performed 1 month after the last HAIC. Histological examination showed necrotic changes with calcification in most parts of the portal vein tumor thrombus as well as the hepatic tumor. Viable tumor tissues composed of well-differentiated adenocarcinoma cells were observed at the marginal site. The patient's disease was pathologically diagnosed as intrahepatic cholangiocellular carcinoma with portal vein tumor thrombus. Twenty-two months after the surgery, the patient is doing well without recurrent disease. Case reports of intrahepatic cholangiocarcinoma with portal vein tumor thrombus are reviewed.

Journal

  • The Japanese Journal of Gastroenterological Surgery

    The Japanese Journal of Gastroenterological Surgery 44(6), 699-705, 2011

    The Japanese Society of Gastroenterological Surgery

Cited by:  1

Codes

  • NII Article ID (NAID)
    130004908038
  • Text Lang
    UNK
  • Article Type
    Journal Article
  • ISSN
    0386-9768
  • Data Source
    CJPref  J-STAGE 
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