Yokota Yuki, Tomimaru Yoshito, Noguchi Kozo, Nagase Hirotsugu, Ogino Takayuki, Hirota Masashi, Oshima Kazuteru, Tanida Tsukasa, Noura Shingo, Kawase Tomono, Imamura Hiroshi, Iwazawa Takashi, Akagi Kenzo, Dono Keizo
Dept. of Surgery, Toyonaka Municipal Hospital.
Gan To Kagaku Ryoho. 2018 Dec;45(13):2205-2207.
A 63-year-old man was referred to our hospital for detailed examinations and treatment of a hepatic tumor. Abdominal contrast-enhanced CT examination showed a huge mass measuring 12 cm in diameter with ring enhancement in the left liver lobe. The liver tumor was accompanied by a macroscopic tumor thrombus in the left portal branch. Under preoperative diagnosis of intrahepatic cholangiocarcinoma with portal vein tumor thrombus, left liver lobectomy, removal of the tumor thrombus, extrahepatic bile duct excision, and lymph node dissection were performed. Histopathological examination of the resected specimens revealed moderately differentiated adenocarcinoma concomitant with tumor thrombus in the left portal branch. Adjuvant chemotherapy with S-1 was administered. However, 3 months after the surgery, CT examination revealed postoperative recurrences in the liver, lung, and bone. Systemic chemotherapy with gemcitabine and cisplatin was administered with radiotherapy for the bone metastasis. However, the chemotherapy was not effective, and 6 months after surgery, he died of the cancer. There have been few reports of cases with ICC accompanied by a macroscopic portal vein tumor thrombus. Based on the reported cases and the present case, prognosis of the disease seems very poor.
一名63岁男性因肝脏肿瘤的详细检查和治疗被转诊至我院。腹部增强CT检查显示左肝叶有一个直径12厘米的巨大肿块，呈环形强化。肝脏肿瘤伴有左门静脉分支的肉眼可见肿瘤血栓。在术前诊断为肝内胆管癌伴门静脉肿瘤血栓的情况下，进行了左肝叶切除术、肿瘤血栓清除术、肝外胆管切除术和淋巴结清扫术。切除标本的组织病理学检查显示为中分化腺癌，伴有左门静脉分支的肿瘤血栓。给予S-1辅助化疗。然而，术后3个月，CT检查显示肝脏、肺和骨出现术后复发。对骨转移灶进行了吉西他滨和顺铂全身化疗及放疗。然而，化疗无效，术后6个月，他死于癌症。关于伴有肉眼可见门静脉肿瘤血栓的肝内胆管癌病例的报道很少。基于已报道的病例和本病例，该病的预后似乎非常差。
