Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 8128582, Japan.
Surg Today. 2012 Dec;42(12):1210-4. doi: 10.1007/s00595-012-0332-4. Epub 2012 Sep 14.
The outcome after surgical resection for intrahepatic cholangiocarcinoma has not been satisfactorily evaluated due to its malignant behavior. Surgical resection, however, has the potential to improve the prognosis and may allow surgeons to experience rare cases with long survival. This report presents the case of a patient who developed recurrence 9 years after resection of intrahepatic cholangiocarcinoma. A 76-year-old female was diagnosed to have intrahepatic cholangiocarcinoma and underwent an extended right posterior subsegmentectomy. The gross appearance showed a mass-forming type tumor. The histopathological examination revealed well to moderately differentiated adenocarcinoma associated with portal vein invasion. Subcutaneous metastasis in the head as the first sign of relapse was diagnosed 9 years after hepatectomy. The histopathological findings of the subcutaneous tumor were similar to those of the intrahepatic cholangiocarcinoma, thus suggesting metastasis from intrahepatic cholangiocarcinoma. Positron emission tomography with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose was useful for detecting multiple metastases. Long-term follow-up for more than 5 years is recommended because the present case shows that late recurrence of intrahepatic cholangiocarcinoma occurs even 5 years after resection.
由于其恶性行为，肝内胆管细胞癌手术后的结果尚未得到满意评估。然而，手术切除有改善预后的潜力，并可能让外科医生遇到罕见的长期存活病例。本报告介绍了 1 例肝内胆管细胞癌切除 9 年后复发的患者。1 名 76 岁女性被诊断为肝内胆管细胞癌，并接受了扩大右后亚段切除术。大体外观显示为肿块型肿瘤。组织病理学检查显示伴有门静脉侵犯的中至高度分化腺癌。肝切除 9 年后，头部皮下转移首先被诊断为复发。皮下肿瘤的组织病理学发现与肝内胆管细胞癌相似，因此提示肝内胆管细胞癌转移。正电子发射断层扫描结合 2-[氟-18]-氟-2-脱氧-D-葡萄糖对于检测多处转移是有用的。由于本例显示肝内胆管细胞癌甚至在切除后 5 年也会发生晚期复发，因此建议进行 5 年以上的长期随访。
