内容紹介
Summary
Double cancer of intrahepatic cholangiocarcinoma and gastric cancer is rare. A 62-year-old man underwent gastrectomy for gastric cancer. The pathological findings were tub1>tub2, m, ly0, v0, n0, StageⅠA. Two years and a month later, a liver tumor(diameter of 3 cm)and a pelvic mass(diameter of 2.5 cm)were observed. Metastasis from gastric cancer was suspected and chemotherapy(SOX)was administered. However, after 5 courses, CT revealed worsening of the liver tumor(diameter of 12 cm)and pelvic mass(diameter of 3 cm). Intrahepatic cholangiocarcinoma and its peritoneal metastasis were also suspected. There was a limit to treatment with chemotherapy, and it was difficult to judge whether to target gastric cancer or intrahepatic cholangiocarcinoma for chemotherapy. In addition, the lesions were localized in the right lobe of the liver and the pelvis. Therefore, we decided to perform resection. As a second-stage operation, pelvic mass extraction and portal vein embolization were performed first. The pathological result of the pelvic mass assessment was mucinous carcinoma. Subsequently, expansive right hepatectomy was performed. The pathological findings were also suggestive of mucinous carcinoma, which was finally diagnosed as intrahepatic cholangiocarcinoma and peritoneal dissemination. Six months after the surgery, several recurrent nodules were observed in the pelvis and GEM plus CDDP was initiated. Currently, 1 year after surgery, there are no restrictions in the activities of daily life of the patient and he is treated on an outpatient basis.
要旨
肝内胆管癌,胃癌の重複癌はまれである。症例は62歳,男性。胃癌に対して幽門側胃切除術を行った。病理結果は,tub1>tub2,m,ly0,v0,n0,StageⅠAであった。2年1か月後,肝腫瘤(径3 cm),骨盤内腫瘤(径2.5 cm)が出現した。胃癌からの転移を疑い,化学療法(SOX)を行ったが,5コース後のCTで肝腫瘤は12 cm大,骨盤内腫瘤は3 cm大で,ともに増悪を示した。肝内胆管癌の異時性重複癌および腹膜転移の可能性も疑われた。化学療法では治療に限界があり,そもそも肝内胆管癌,胃癌いずれを標的とすべきか判断が困難であったこと,病変は肝臓右葉と骨盤内に1か所ずつで限局していることから切除の方針とした。二期的手術とし,まず骨盤内腫瘤摘出術および門脈塞栓術を行った。骨盤内腫瘤の病理結果は粘液癌であった。その後,拡大右肝切除術を行った。病理結果は粘液癌であり,最終的に肝内胆管癌,腹膜播種と診断した。術後6か月で骨盤内に数個の播種再発がありGEM+CDDPを開始した。現在術後1年,日常生活に制限はなく外来通院中である。
目次
Double cancer of intrahepatic cholangiocarcinoma and gastric cancer is rare. A 62-year-old man underwent gastrectomy for gastric cancer. The pathological findings were tub1>tub2, m, ly0, v0, n0, StageⅠA. Two years and a month later, a liver tumor(diameter of 3 cm)and a pelvic mass(diameter of 2.5 cm)were observed. Metastasis from gastric cancer was suspected and chemotherapy(SOX)was administered. However, after 5 courses, CT revealed worsening of the liver tumor(diameter of 12 cm)and pelvic mass(diameter of 3 cm). Intrahepatic cholangiocarcinoma and its peritoneal metastasis were also suspected. There was a limit to treatment with chemotherapy, and it was difficult to judge whether to target gastric cancer or intrahepatic cholangiocarcinoma for chemotherapy. In addition, the lesions were localized in the right lobe of the liver and the pelvis. Therefore, we decided to perform resection. As a second-stage operation, pelvic mass extraction and portal vein embolization were performed first. The pathological result of the pelvic mass assessment was mucinous carcinoma. Subsequently, expansive right hepatectomy was performed. The pathological findings were also suggestive of mucinous carcinoma, which was finally diagnosed as intrahepatic cholangiocarcinoma and peritoneal dissemination. Six months after the surgery, several recurrent nodules were observed in the pelvis and GEM plus CDDP was initiated. Currently, 1 year after surgery, there are no restrictions in the activities of daily life of the patient and he is treated on an outpatient basis.
要旨
肝内胆管癌,胃癌の重複癌はまれである。症例は62歳,男性。胃癌に対して幽門側胃切除術を行った。病理結果は,tub1>tub2,m,ly0,v0,n0,StageⅠAであった。2年1か月後,肝腫瘤(径3 cm),骨盤内腫瘤(径2.5 cm)が出現した。胃癌からの転移を疑い,化学療法(SOX)を行ったが,5コース後のCTで肝腫瘤は12 cm大,骨盤内腫瘤は3 cm大で,ともに増悪を示した。肝内胆管癌の異時性重複癌および腹膜転移の可能性も疑われた。化学療法では治療に限界があり,そもそも肝内胆管癌,胃癌いずれを標的とすべきか判断が困難であったこと,病変は肝臓右葉と骨盤内に1か所ずつで限局していることから切除の方針とした。二期的手術とし,まず骨盤内腫瘤摘出術および門脈塞栓術を行った。骨盤内腫瘤の病理結果は粘液癌であった。その後,拡大右肝切除術を行った。病理結果は粘液癌であり,最終的に肝内胆管癌,腹膜播種と診断した。術後6か月で骨盤内に数個の播種再発がありGEM+CDDPを開始した。現在術後1年,日常生活に制限はなく外来通院中である。