Adikrisna Rama, Nakamura Noriaki, Irie Takumi, Matsumura Satoshi, Tanaka Shinji, Arii Shigeki
Dept. of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University.
Gan To Kagaku Ryoho. 2014 Jan;41(1):117-20.
A 74-year-old woman was referred to our hospital following the diagnosis of advanced gallbladder cancer with para-aortic lymph node metastasis. Combination treatment involving gemcitabine(1,000mg/m / 2 body surface area)and CDDP(50mg/ m2 body surface area)was initiated and repeated for 4 courses; gemcitabine was administrated on day 1 and day 8, whereas CDDP was administrated on day 8, followed by 1 week of no treatment. After 4 courses, abdominal computed tomography (CT)indicated a reduction in size of the main lesion and disappearance of para -aortic lymph nodes. The remarkable response to the chemotherapy, which resulted in tumor downstaging, enabled us to perform the curative surgery procedure. Thus, cholecystectomy with resection of the hepatic bed and lymph node dissection were performed. The resected specimens indicated papillary adenocarcinoma of the gallbladder infiltrating the muscular wall of the gallbladder. In addition, the resected para-aortic lymph nodes indicated hyalinization and fibrosis as a result of the chemotherapy. Moreover, the pericholedocal lymph nodes were necrotic and no viable tumor was noted, thus indicating the excellent response to the chemotherapy.
一名74岁女性在被诊断为晚期胆囊癌伴主动脉旁淋巴结转移后转诊至我院。开始采用吉西他滨（1000mg/m²体表面积）和顺铂（50mg/m²体表面积）联合治疗，并重复4个疗程；吉西他滨在第1天和第8天给药，顺铂在第8天给药，随后1周不进行治疗。4个疗程后，腹部计算机断层扫描（CT）显示主要病灶缩小，主动脉旁淋巴结消失。化疗的显著反应导致肿瘤降期，使我们能够进行根治性手术。因此，进行了胆囊切除术，包括肝床切除和淋巴结清扫。切除标本显示为浸润胆囊肌层的胆囊乳头状腺癌。此外，切除的主动脉旁淋巴结因化疗出现玻璃样变和纤维化。而且，肝门周围淋巴结坏死，未发现存活肿瘤，表明对化疗反应良好。
