Jiao Xin, Zhai Mi-Mi, Xing Fang-Zhou, Wang Xiao-Ling
Department of Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang 261041, Shandong Province, China.
Department of Digestive System, Weifang People's Hospital, Weifang 261041, Shandong Province, China.
World J Clin Cases. 2023 Jun 26;11(18):4446-4453. doi: 10.12998/wjcc.v11.i18.4446.
Cholangiocarcinoma and small intestine cancer are common clinical malignancies, but metastatic cholangiocarcinoma and small intestine cancer are rare, especially simultaneous metastatic cholangiocarcinoma and small intestine cancer from breast cancer. Since the clinical presentation of metastatic cholangiocarcinoma and small intestine cancer does not differ from primary tumor, it may lead to misdiagnosis preoperatively.
A 66-year-old woman was admitted to our hospital for further treatment due to abdominal pain and jaundice. Abdominal magnetic resonance imaging and magnetic resonance cholangiopancreatography showed an occupying lesion of the bile duct, considering a high possibility of primary bile duct tumor. Therefore, we performed a radical bile duct cancer surgery and cholecystectomy, and multiple tumors in the small intestine were found and removed during the surgery process. Postoperative pathology showed metastatic bile duct cancer and small intestine cancer from tumors in other parts. The patient underwent a right total mastectomy and axillary lymph node dissection because of right breast cancer 2 years ago. Combining with the immunohistochemical results, the patient was finally diagnosed as metastatic cholangiocarcinoma and metastatic small intestine cancer from breast cancer. Postoperatively, the patient received four cycles of chemotherapy and targeted therapy with docetaxel, capecitabine and trastuzumab. Unfortunately, the patient eventually died from tumor progression, thoracoabdominal infection, and sepsis 5 mo after surgery.
Simultaneous metastatic cholangiocarcinoma and small intestine cancer from breast cancer are rare and the prognosis is extremely poor. Improving preoperative diagnostic accuracy is beneficial to avoid excessive surgical treatment. Treatment should be aimed at relieving biliary obstruction and abdominal pain, and then supplemented with chemotherapy and targeted therapy to control tumor progression and prolong the patient's life.
胆管癌和小肠癌是临床常见的恶性肿瘤，但转移性胆管癌和小肠癌较为罕见，尤其是同时发生的来自乳腺癌的转移性胆管癌和小肠癌。由于转移性胆管癌和小肠癌的临床表现与原发性肿瘤无异，术前可能导致误诊。
一名66岁女性因腹痛和黄疸入院接受进一步治疗。腹部磁共振成像和磁共振胰胆管造影显示胆管有占位性病变，考虑原发性胆管肿瘤可能性大。因此，我们进行了根治性胆管癌手术和胆囊切除术，术中发现并切除了小肠中的多个肿瘤。术后病理显示为其他部位肿瘤转移至胆管癌和小肠癌。该患者2年前因右乳腺癌接受了右乳全切术和腋窝淋巴结清扫术。结合免疫组化结果，最终诊断为乳腺癌转移至胆管癌和小肠癌。术后，患者接受了四个周期的多西他赛、卡培他滨和曲妥珠单抗化疗及靶向治疗。不幸的是，患者最终在术后5个月因肿瘤进展、胸腹感染和脓毒症死亡。
同时发生的来自乳腺癌的转移性胆管癌和小肠癌罕见，预后极差。提高术前诊断准确性有利于避免过度手术治疗。治疗应以缓解胆道梗阻和腹痛为目标，然后辅以化疗和靶向治疗以控制肿瘤进展并延长患者生命。
