A Case of Synchronous Combined Cancer With Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma 39 Years After Operation for Biliary Atresia

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  • Arai Yuhki
    Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Science
  • Kubota Masayuki
    Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Science
  • Kobayashi Takashi
    Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Science
  • Ohyama Toshiyuki
    Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Science
  • Yokota Naoki
    Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Science

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Other Title
  • 胆道閉鎖症の術後39年目に発生した肝細胞癌と肝内胆管癌の同時性重複癌の1例
  • 症例報告 胆道閉鎖症の術後39年目に発生した肝細胞癌と肝内胆管癌の同時性重複癌の1例
  • ショウレイ ホウコク タンドウ ヘイサショウ ノ ジュツゴ 39ネンメ ニ ハッセイ シタ カン サイボウ ガン ト カン ナイタンカン ガン ノ ドウジセイ チョウフクガン ノ 1レイ

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Abstract

<p>Long-term survivors without liver transplantation after Kasai have the problem of hepatic cancerization. Here, we report the case of a patient who developed intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC), i.e., combined HCC type, after surgery for biliary atresia (BA). The patient was a 39-year-old male who underwent jejunal interposition hepatic portoduodenostomy for BA, I-b2-γ type, 85 days after birth. Esophageal varices appeared when he was 10 years old and worsened from 17 years of age. He had cholangitis repeatedly at 27 years of age and liver cirrhosis with ascites at 35 years of age. The tumor markers were rising and a two-pathologic-type lesion in S1 was pointed out in imaging studies; thus, he was diagnosed as having ICC and HCC (combined HCC type). Combined HCC showed T3cN0cM0 clinical stage III and liver damage C; thus, he underwent transcatheter arterial chemoembolization (TACE). HCC showed complete necrosis, but ICC showed no mass reduction; thus, we performed gemcitabine chemotherapy. Although he underwent chemotherapy with gemcitabine, the tumor size continued to increase and liver failure developed. He died 8 months after treatment. This is the only case of the combined HCC type and the oldest among all cases of hepatic cancer after surgery for BA. Because all patients with cholangiocarcinoma died after surgery, their prognosis was considered poor. In the follow up of long-term survivors without liver transplantation, it is considered that management for ICC after operation is important.</p>

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