Kato Tomokatsu, Matsuo Yoichi, Ueda Goro, Aoyama Yoshinaga, Omi Kan, Hayashi Yuichi, Imafuji Hiroyuki, Saito Kenta, Tsuboi Ken, Morimoto Mamoru, Ogawa Ryo, Takahashi Hiroki, Naitoh Itaru, Hayashi Kazuki, Takiguchi Shuji
Dept. of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences.
Gan To Kagaku Ryoho. 2020 Dec;47(13):2204-2206.
The case is a 59-year-old woman. A medical examination revealed a high CA19-9, she visited a nearby hospital. Abdominal echo showed thickening of the gallbladder wall, and she was referred to our hospital for further examination. EUS-FNA was performed and a biopsy of #12 lymph node revealed undifferentiated cancer, which was diagnosed as gallbladder cancer. FDG-PET showed accumulation of FDG in the gallbladder lumen and swollen lymph nodes around the aorta. Therefore, the cancer was considered unresectable and chemotherapy was performed. FDG-PET was re-examined after 4 courses of gemcitabine plus cisplatin combination chemotherapy. As a result, the lymph node swelling contracted, the accumulation of FDG disappeared, and surgery was scheduled. Extended cholecystectomy and extrahepatic bile duct resection were performed. She was discharged 22 days after the surgery without complications. Histopathological examination showed fibrotic tissue at the gallbladder and lymph nodes, but no residual tumor cells. There are no recurrences 11 months after surgery. Although the prognosis of gallbladder cancer with para-aortic lymph node metastasis is generally poor, it is suggested that conversion surgery with multimodality treatment including preoperative chemotherapy may be a useful therapeutic strategy.
该病例为一名59岁女性。体检发现CA19-9升高，她前往附近医院就诊。腹部超声显示胆囊壁增厚，随后她被转诊至我院进行进一步检查。进行了超声内镜引导下细针穿刺活检（EUS-FNA），对12号淋巴结的活检显示为未分化癌，诊断为胆囊癌。氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）显示胆囊腔内及主动脉周围肿大淋巴结有FDG聚集。因此，考虑该癌症无法切除，遂进行化疗。在接受4个疗程的吉西他滨联合顺铂化疗后复查FDG-PET。结果，淋巴结肿大缩小，FDG聚集消失，遂安排手术。实施了扩大胆囊切除术及肝外胆管切除术。术后22天出院，无并发症。组织病理学检查显示胆囊和淋巴结处为纤维化组织，但无残留肿瘤细胞。术后11个月无复发。尽管伴有主动脉旁淋巴结转移的胆囊癌预后通常较差，但提示包括术前化疗在内的多模式治疗的转化手术可能是一种有效的治疗策略。
