Kamitani Naoki, Nomi Takeo, Hokuto Daisuke, Yoshikawa Takahiro, Matsuo Yasuko, Sho Masayuki
Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara 634-8522 Japan.
Int Cancer Conf J. 2020 Aug 18;9(4):244-248. doi: 10.1007/s13691-020-00436-0. eCollection 2020 Oct.
A 64-year-old man was diagnosed with cholangiocellular carcinoma based on preoperative computed tomography and magnetic resonance imaging and underwent laparoscopic segmentectomy (Segment 8) of the liver for radical operation. Pathological examination revealed the presence of an undifferentiated carcinoma with osteoclast-like giant cells, which were categorized as T3N0M0 and Stage III based on the third English edition of the Japanese classification of liver cancer. The patient was treated with three courses of combination chemotherapy, which included gemcitabine (1000 mg/m) and cisplatin (25 mg/m), as well as S-1 (120 mg/day) for adjuvant chemotherapy. At two months after the operation, CT revealed multiple liver- and lung metastases. Thereafter, the patient was prescribed the molecularly targeted drug, lenvatinib (12 mg/day). However, lenvatinib was not effective, as evident by the extension of several metastases. Testing for microsatellite instability was negative. The patient died 5 months after the operation. We experienced a case of primary undifferentiated carcinoma with osteoclast-like giant cells in the liver showed rapidly developing multiple metastases after curative liver resection.
一名64岁男性根据术前计算机断层扫描和磁共振成像被诊断为胆管细胞癌，并接受了腹腔镜肝段切除术（第8段）以进行根治性手术。病理检查发现存在具有破骨细胞样巨细胞的未分化癌，根据日本肝癌分类第三版英文版本，其被归类为T3N0M0，III期。患者接受了三个疗程的联合化疗，包括吉西他滨（1000mg/m）和顺铂（25mg/m），以及S-1（120mg/天）进行辅助化疗。术后两个月，CT显示多发肝转移和肺转移。此后，患者开始使用分子靶向药物乐伐替尼（12mg/天）。然而，乐伐替尼无效，数处转移灶增大即为明证。微卫星不稳定性检测为阴性。患者术后5个月死亡。我们遇到一例肝脏原发性未分化癌伴破骨细胞样巨细胞，在根治性肝切除术后出现快速进展的多发转移。
