Hata Tomoki, Yasuyama Akinobu, Hara Takeo, Okano Miho, Takayama Osamu, Kim Yongkook, Hasegawa Junichi, Imamoto Haruhiko
Dept. of Surgery, Kaizuka City Hospital.
Gan To Kagaku Ryoho. 2025 Feb;52(2):167-169.
The patient was a 66-year-old man. He came to our hospital because of abdominal discomfort. A CT scan revealed hypovascular tumors of about 70 mm in the S4/5 and 16 mm in the S6 of the liver. The S4/5 tumor was directly invasive into the greater omentum and abdominal wall, and a nodule suspected of peritoneal dissemination was observed around the tumor. Based on tumor biopsy results, a diagnosis of intrahepatic cholangiocarcinoma(ICC), cT3N0M1, Stage ⅣB was made. A total of 9 courses of GCD therapy(gemcitabine+cisplatin+durvalumab)were performed for ICC and the tumor was found to have shrunk, and the S6 tumor was obscured. The FDG-PET/CT scan also showed similar results, and the patient was judged to be curative, and surgery was performed 8 months after the initial diagnosis. Laparoscopic hepatic S4a/5 subsegmentectomy and S6 partial hepatectomy were performed. Intraoperative findings showed no peritoneal dissemination, and cytology of washed ascites was negative. Histopathological examination did not reveal any tumor cells, and the patient was judged to have a pathological complete response(pCR). There are few reports of ICC with pCR after GCD therapy, and we report this case here with a review of the literature.
患者为一名66岁男性。他因腹部不适前来我院就诊。CT扫描显示肝脏S4/5段有一个约70mm的乏血供肿瘤，S6段有一个16mm的肿瘤。S4/5段肿瘤直接侵犯大网膜和腹壁，肿瘤周围可见一个疑似腹膜播散的结节。根据肿瘤活检结果，诊断为肝内胆管癌（ICC），cT3N0M1，ⅣB期。针对ICC共进行了9个疗程的GCD治疗（吉西他滨+顺铂+度伐利尤单抗），发现肿瘤缩小，S6段肿瘤显示不清。FDG-PET/CT扫描也显示了类似结果，患者被判定为可治愈，并在初次诊断8个月后进行了手术。实施了腹腔镜肝S4a/5亚段切除术和S6部分肝切除术。术中发现无腹膜播散，冲洗腹水的细胞学检查为阴性。组织病理学检查未发现任何肿瘤细胞，患者被判定为病理完全缓解（pCR）。GCD治疗后出现pCR的ICC报道较少，我们在此报告该病例并进行文献复习。
