A Case of Choledochal Carcinoid with Liver Metastasis Responding to Hepatic Arterial Infusion Immuno-chemotherapy

Katsuyuki Kunieda, Shigetoyo Saji, Iwao Kumazawa, Yasuyuki Sugiyama, Kiichi Miya, Kuniyasu Shimokawa*

Second Department of Surgery, The Department of Laboratory Medicine* Gifu University School of Medicine

An extremely rare case of bile duct carcinoid with liver metastasis, which showed a partial response to hepatic arterial infusion immuno-chemotherapy, is reported. A 42-year-old woman with general fatigue from August 1989 consulted a doctor. She had obstructive jaundice and was admitted to our hospital for closer examination and surgical therapy. Preoperative imaging studies showed dilatation of the intrahepatic duct, a filling defect in the middle of the common bile duct and multiple liver metastases. After a diagnosis of bile duct cancer with liver metastasis, she underwent laparotomy, and a small, finger-head sized tumor at the common bile duct was found with metastatic lymph nodes (No. 8, 12) and liver metastases (S₄, S₂, S₇). We resected the common bile duct with D₂, lymph node dissection and established a hepatic arterial infusion port. The resected specimen showed a hard whitish tumor 12×10×6 mm in size. The histological diagnosis was bile duct carcinoma from the structure of solid nests and cords and the existence of Grimelius-positive cells. The tumor also had component of poorly differentiated adenocarcinoma. After 8 courses of hepatic arterial infusion immuno-chemotherapy with mitomycin C, recombinant interleukin 2 and OK-432, the liver metastases became smaller and a partial response was detected by computed tomography. But, she rejected further chemotherapy and did not visit our hospital for a long period. She died of peritoneal and liver metastasis 3 years and 5 months after the operation.

Key words
choledochal carcinoid, bile duct carcinoid, hepatic arterial infusion immuno-chemo-therapy

Reprint requests
Katsuyuki Kunieda Second Department of Surgery, Gifu University School of Medicine
40 Tsukasa-machi, Gifu, 500 JAPAN

Accepted
June 11, 1997

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