Terashima Takahiro, Kawamoto Shunji, Maekawa Kouichi, Kuroki Norimitsu
Dept. of Surgery, Shonan Atsugi Hospital.
Gan To Kagaku Ryoho. 2020 Apr;47(4):691-693.
A 65-year-old man was diagnosed with biliary carcinoma. Abdominal CT showed a tumor at the inferior bile duct. Tumor cells with small cell carcinoma were confirmed with biopsy of ERCP. Although the tumor seemed to be resectable, ERCP caused pancreatitis. We decided to perform surgery after the pancreatitis had healed to initiate neoadjuvant chemotherapy. According to the guideline of pancreatic NET(G3), we adopted the regimen of CDDP plus VP-16. After 2 courses, CT revealed that there were no changes in tumor size and that the pancreatitis was healing. We then performed pancreatoduodenectomy. Histological examination of the specimen demonstrated small cell NEC of the bile duct. Five months after the operation, multiple liver metastases manifested, leading to liver failure and death. NEC of the bile duct is known to be a highly malignant tumor with a poor prognosis. Further evaluation is needed to elucidate optimal therapy for biliary NEC.
一名65岁男性被诊断为胆管癌。腹部CT显示肝下胆管有肿瘤。通过ERCP活检确诊为小细胞癌的肿瘤细胞。尽管肿瘤似乎可以切除，但ERCP引发了胰腺炎。我们决定在胰腺炎治愈后进行手术，并开始新辅助化疗。根据胰腺神经内分泌肿瘤（G3）的指南，我们采用了顺铂加依托泊苷的方案。两个疗程后，CT显示肿瘤大小没有变化，胰腺炎正在愈合。然后我们进行了胰十二指肠切除术。标本的组织学检查显示为胆管小细胞神经内分泌癌。术后五个月，出现多处肝转移，导致肝衰竭和死亡。胆管神经内分泌癌是一种已知的高恶性肿瘤，预后较差。需要进一步评估以阐明胆管神经内分泌癌的最佳治疗方法。
