A Case of Intrahepatic Cholangiocellular Carcinoma with Portal Vein Tumor Thrombus Treated with Surgery after Hepatic Arterial Infusion Chemotherapy

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 44; no. 6; pp. 699 - 705
• Main Authors: Uno, Akihiro, Matsumoto, Keigo, Suzuki, Shohachi, Kitamura, Hiroshi, Ochiai, Hideto, Saida, Yasuhiko, Inuzuka, Kazunori, Tanioka, Fumihiko, Jindo, Osamu, Tatsuno, Genki
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 2011
• Subjects: hepatic arterial infusion chemotherapy; intrahepatic cholangiocarcinoma; portal vein tumor thrombus
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.44.699

A 62 year-old woman visited our hospital for further evaluation of a liver tumor detected by abdominal ultrasonography in an annual medical examination. Hepatitis B and C virus markers were negative. Serum CA19-9 level was elevated to 281.6U/ml. Abdominal computed tomography showed an inhomogeneous tumor 5cm in diameter with bile duct dilatation in the left lateral segment of the liver and the presence of tumor thrombus in the left portal vein. The margin of the hepatic tumor was slightly enhanced in the arterial phase. Intrahepatic cholangiocellular carcinoma or combined hepatocellular and cholangiocarcinoma accompanied by tumor thrombus extending from the left portal vein to the bifurcation of the portal vein was highly suspected. Hepatic arterial infusion chemotherapy (HAIC) by weekly high dose administration of 5-FU (1,000mg/one time) was performed 10 times, prior to the surgery. The hepatic tumor was reduced to 3cm in size with portal tumor thrombus regression. Extended left hepatectomy with biliary tract reconstruction, lymph node dissection, and portal vein reconstruction was performed 1 month after the last HAIC. Histological examination showed necrotic changes with calcification in most parts of the portal vein tumor thrombus as well as the hepatic tumor. Viable tumor tissues composed of well-differentiated adenocarcinoma cells were observed at the marginal site. The patient's disease was pathologically diagnosed as intrahepatic cholangiocellular carcinoma with portal vein tumor thrombus. Twenty-two months after the surgery, the patient is doing well without recurrent disease. Case reports of intrahepatic cholangiocarcinoma with portal vein tumor thrombus are reviewed.