Kanomata Hiroyuki, Seyama Yasuji, Kudo Hiroki, Tanizawa Toru, Warabi Masahiro, Takahashi Masamichi, Matsuoka Yujiro, Wada Ikuo, Takegami Masayuki, Miyamoto Yukio, Umekita Nobutaka
Dept. of Surgery, Tokyo Metropolitan Bokutoh Hospital.
Gan To Kagaku Ryoho. 2018 Apr;45(4):746-748.
Double cancer of intrahepatic cholangiocarcinoma and gastric cancer is rare. A 62-year-old man underwent gastrectomy for gastric cancer. The pathological findings were tub1>tub2, m, ly0, v0, n0, Stage I A. Two years and a month later, a liver tumor(diameter of 3 cm)and a pelvic mass(diameter of 2.5 cm)were observed. Metastasis from gastric cancer was suspected and chemotherapy(SOX)was administered. However, after 5 courses, CT revealed worseningof the liver tumor (diameter of 12 cm)and pelvic mass(diameter of 3 cm). Intrahepatic cholangiocarcinoma and its peritoneal metastasis were also suspected. There was a limit to treatment with chemotherapy, and it was difficult to judge whether to target gastric cancer or intrahepatic cholangiocarcinoma for chemotherapy. In addition, the lesions were localized in the right lobe of the liver and the pelvis. Therefore, we decided to perform resection. As a second-stage operation, pelvic mass extraction and portal vein embolization were performed first. The pathological result of the pelvic mass assessment was mucinous carcinoma. Subsequently, expansive right hepatectomy was performed. The pathological findings were also suggestive of mucinous carcinoma, which was finally diagnosed as intrahepatic cholangiocarcinoma and peritoneal dissemination. Six months after the surgery, several recurrent nodules were observed in the pelvis and GEM plus CDDP was initiated. Currently, 1 year after surgery, there are no restrictions in the activities of daily life of the patient and he is treated on an outpatient basis.
肝内胆管癌和胃癌双重癌较为罕见。一名62岁男性因胃癌接受了胃切除术。病理结果为tub1>tub2，m，ly0，v0，n0，ⅠA期。两年零一个月后，观察到肝脏肿瘤（直径3cm）和盆腔肿块（直径2.5cm）。怀疑是胃癌转移，于是给予化疗（SOX方案）。然而，5个疗程后，CT显示肝脏肿瘤（直径12cm）和盆腔肿块（直径3cm）增大。也怀疑有肝内胆管癌及其腹膜转移。化疗治疗存在局限性，难以判断化疗是针对胃癌还是肝内胆管癌。此外，病变局限于肝脏右叶和盆腔。因此，我们决定进行手术切除。作为二期手术，首先进行盆腔肿块切除和门静脉栓塞。盆腔肿块评估的病理结果为黏液癌。随后，进行了扩大右肝切除术。病理结果也提示为黏液癌，最终诊断为肝内胆管癌伴腹膜播散。手术后6个月，在盆腔观察到几个复发结节，于是开始使用吉西他滨加顺铂治疗。目前，手术后1年，患者日常生活活动不受限，门诊治疗。
