Dandan Hu1, Yilei Mao2. 1Sun Yat-sen University Cancer Center, 2Peking Union Medical College Hospital
Potential good prognosis of preclinical cholangiocarcinoma underwent laparoscopic liver segmentectomy.
A 76 years old male presented to gastroenterology department on January 4, 2016, with progressively increasing carbohydrate antigen 19-9 (Ca19-9) level.
Clinical manifestations only include a blood stool with less than 10ml/d, with occasionally tenesmus. No special findings about physical examinations.
Past history includes middle segmentectomy of left lung in 1964, post-operation pathology implied tuberculosis. In 2013, he went through radical prostatectomy (Gleason 3+3, T2cN0Mo). In 2014, he was discovered to have elevated PSA level and went through 1-month radiotherapy. Now, he is on oral bicalutamide medication. In 2015, as he developed groin hernia, a tension-free hernioplasty was performed. He has hypertension, diabetes mellitus, and hemorrhoid as well. He also has 5-years history of hypertension, diabetes mellitus, and hemorrhoids.
Ca19-9 level was 237.9 (reference range: 0-34.0) on October 28, 2015. It rose to 310.5 on December 2, 2015. After admission, another test was done on January 4, 2016, and the figure rocketed to 338.3. Meanwhile, Ca242 were 118.9, >150, > 150 respectively (0-20), cyfra 211 were 8.11, 9.22, 6.36 respectively (0-3.5). AFP and CEA were negative.
As for this patient, he is of high risk of hepatobiliary system diseases. Due to common bile duct calculi, ERCP was applied in 2010. He was affected by recurrent cystitis, and an open cystectomy surgery was performed in 2011, along with common bile duct incision, lithotomy under choledochoscope, and T tube drainage. Post-surgical pathology showed no evidence of tumor cells. His serum tests indicated that he was previously infected with hepatitis virus B.
After admission, a contrast enhanced computer tomography was performed and no malignancy was reported. PET/CT was suggested and a 3.6*3.7*2.7cm high standard uptake value (SUVmax=6.0) lesion was indicated at the margin of left lobe of liver, where it can hardly distinguish the relationship between the lesion and lesser curvature of stomach.
After consultation by Department of Liver Surgery, laparoscopic left liver segmentectomy under general anesthesia was performed on January 19, 2016. The surgery lasted for 200 minutes, with less than 100ml bleeding. The lesion was 3*1.8*2.5cm, soft, parenchymal, partly enveloped, and its section is gray and poorly demarcated. Pathology reported it was poorly differentiated cholangiocarcinoma with necrosis, AFP(-), CAM5.2(+), CD34(vessel +), CEA(+), CK19(+), CK7(+), CK8(+), EGFR(+), Hepatocyte(-), Ki-67(index 30%). Margin was negative.
Ca19-9 dropped to 107 7 days after the surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86228
Program Number: P129
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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