内容紹介
Summary
A 65-year-old man was diagnosed with biliary carcinoma. Abdominal CT showed a tumor at the inferior bile duct. Tumor cells with small cell carcinoma were confirmed with biopsy of ERCP. Although the tumor seemed to be resectable, ERCP caused pancreatitis. We decided to perform surgery after the pancreatitis had healed to initiate neoadjuvant chemotherapy. According to the guideline of pancreatic NET(G3), we adopted the regimen of CDDP plus VP-16. After 2 courses, CT revealed that there were no changes in tumor size and that the pancreatitis was healing. We then performed pancreatoduodenectomy. Histological examination of the specimen demonstrated small cell NEC of the bile duct. Five months after the operation, multiple liver metastases manifested, leading to liver failure and death. NEC of the bile duct is known to be a highly malignant tumor with a poor prognosis. Further evaluation is needed to elucidate optimal therapy for biliary NEC.
要旨
症例は65歳,男性。胆管癌の疑いにて他院より紹介された。ERCP下生検にてsmall cell carcinomaを認め,胆管原発神経内分泌癌(neuroendocrine carcinoma: NEC)と診断した。高度脈管浸潤や遠隔転移を認めず,手術適応と考えられた。しかしERCP後膵炎を認め,膵炎が改善してから手術を行うこととし,その間に術前化学療法(CDDP+VP-16)を2コース施行した。化学療法後のCTでは腫瘍のサイズに著変なく,新たな遠隔転移・リンパ節腫大などは認めなかった。化学療法開始から2か月後に手術を施行した。病理組織学的結果はNEC,核分裂像数24/10 HPF,NEC(G3),T2,N1,DM0,HM0,EM1,M0,StageⅡb。術後化学療法は施行しなかった。術後5か月のCTにて多発肝転移を認めた。胆管原発NEC症例が少なく術前化学療法の報告はほとんどみられない。今後も胆管NECの症例を集積し治療戦略を検討する必要がある。
目次
A 65-year-old man was diagnosed with biliary carcinoma. Abdominal CT showed a tumor at the inferior bile duct. Tumor cells with small cell carcinoma were confirmed with biopsy of ERCP. Although the tumor seemed to be resectable, ERCP caused pancreatitis. We decided to perform surgery after the pancreatitis had healed to initiate neoadjuvant chemotherapy. According to the guideline of pancreatic NET(G3), we adopted the regimen of CDDP plus VP-16. After 2 courses, CT revealed that there were no changes in tumor size and that the pancreatitis was healing. We then performed pancreatoduodenectomy. Histological examination of the specimen demonstrated small cell NEC of the bile duct. Five months after the operation, multiple liver metastases manifested, leading to liver failure and death. NEC of the bile duct is known to be a highly malignant tumor with a poor prognosis. Further evaluation is needed to elucidate optimal therapy for biliary NEC.
要旨
症例は65歳,男性。胆管癌の疑いにて他院より紹介された。ERCP下生検にてsmall cell carcinomaを認め,胆管原発神経内分泌癌(neuroendocrine carcinoma: NEC)と診断した。高度脈管浸潤や遠隔転移を認めず,手術適応と考えられた。しかしERCP後膵炎を認め,膵炎が改善してから手術を行うこととし,その間に術前化学療法(CDDP+VP-16)を2コース施行した。化学療法後のCTでは腫瘍のサイズに著変なく,新たな遠隔転移・リンパ節腫大などは認めなかった。化学療法開始から2か月後に手術を施行した。病理組織学的結果はNEC,核分裂像数24/10 HPF,NEC(G3),T2,N1,DM0,HM0,EM1,M0,StageⅡb。術後化学療法は施行しなかった。術後5か月のCTにて多発肝転移を認めた。胆管原発NEC症例が少なく術前化学療法の報告はほとんどみられない。今後も胆管NECの症例を集積し治療戦略を検討する必要がある。