Department of Medical Oncology, Rajiv Gandhi Cancer Hospital, Sector 5, Rohini, New Delhi, India.
Hepatobiliary Pancreat Dis Int. 2010 Jun;9(3):325-8.
Gastrointestinal cancers, especially pancreatobiliary cancers, are frequently associated with or are complicated by thromboembolic phenomena due to hypercoagulability and/or altered venous drainage, especially of the abdomen and lower limbs. This report describes an unusual and interesting case of gallbladder carcinoma developing a viable tumor thrombus in the superior vena cava (SVC) with resultant SVC obstruction, while on gefitinib-based anti-epidermal growth factor receptor (EGFR) therapy.
A 60-year-old woman was incidentally diagnosed to have gallbladder cancer on cholecystectomy. She had disease recurrence and received systemic chemotherapy followed by gefitinib-based anti-EGFR therapy. Subsequently, while on gefitinib-based therapy, she presented with clinical signs and symptoms suggestive of SVC thrombosis.
A whole body PET scan revealed a metabolically active tumor thrombus in the SVC, besides other sites of metabolically active disease inclusive of the lung parenchyma, lymph nodes and abdomen. She was treated with anti-thrombotics and external beam radiotherapy directed to the SVC thrombus leading to symptomatic relief. She continues to survive on the day of writing this report.
This rare complication, though theoretically possible, is unreported because of the short overall survival of advanced gallbladder cancer patients. This highlights that with the availability of better chemotherapeutic/biotherapeutic agents for increasing in the lifespan of cancer patients, we may come across such cases more frequently in the future.
胃肠道癌症，尤其是胰胆管癌，由于高凝状态和/或静脉引流改变，尤其是腹部和下肢，常伴有或并发血栓栓塞现象。本报告描述了一例不常见且有趣的病例，胆囊癌在上腔静脉（SVC）中形成有活力的肿瘤血栓，导致 SVC 阻塞，而患者正在接受基于吉非替尼的表皮生长因子受体（EGFR）治疗。
一名 60 岁女性在胆囊切除术后意外被诊断出患有胆囊癌。她的疾病复发，接受了全身化疗，随后接受了基于吉非替尼的抗 EGFR 治疗。随后，在接受基于吉非替尼的治疗期间，她出现了提示 SVC 血栓形成的临床症状和体征。
全身 PET 扫描显示 SVC 内有代谢活跃的肿瘤血栓，此外还有其他代谢活跃的病变部位，包括肺实质、淋巴结和腹部。她接受了抗血栓药物和针对 SVC 血栓的外部束放疗治疗，症状得到缓解。在撰写本报告的当天，她仍在继续存活。
这种罕见的并发症虽然理论上可能发生，但由于晚期胆囊癌患者的总体生存时间较短，因此尚未报道。这表明，随着更好的化疗/生物治疗药物的出现，延长了癌症患者的寿命，我们将来可能会更频繁地遇到此类病例。
