Gallbladder Carcinoma with a Solitary Hepatic Metastasis Treated by Surgery and Liver-perfusion Chemotherapy. A Case Report of Long-term Survivor

Takamichi Komori, Osamu Ishikawa, Hiroaki Ohigashi, Shigekazu Yokoyama, Yo Sasaki, Terumasa Yamada, Tsutomu Kasugai^* and Shingi Imaoka

Departments of Surgery and Pathology^*, Osaka Medical Center for Cancer and Cardiovascular Diseases

A 62-year-old woman referred with high fever and right hypochondriac pain in March 1995 was found in abdominal ultrasonography to have a large mass 10 cm in diameter occupying the body and the fundus of the gallbladder, suggesting gall bladder carcinoma, plus 3 stones 1 cm in diameter in the neck of the gallbladder. At surgery, the liver bed next to the gallbladder, 1 cm wide, was grayish white, suggesting hepatic invasion of gallbladder carcinoma. The gallbladder, segments 4a and 5 of the liver, and the common bile duct were resected. Histologically, the 65-mm-diameter tumor was papillary adenocarcinoma, which showed serosal and high-grade angiolymphatic invasion, with lymph node metastasis. The grayish-white liver bed showed high-grade inflammatory change with marked fibrosis but no cancer invasion. A solitary metastatic lesion 8 mm in diameter was detected in the resected liver. To prevent hepatic cancer recurrence, continuous infusion chemotherapy (5-FU) was con conducted postoperatively into the hepatic artery for 20 weeks and the portal vein for 4 weeks via catheters placed at operation. She remains alive without cancer recurrence in the over 7 years since surgery. Incidental resection of liver metastasis plus liver-perfusion chemotherapy seemed to have contributed to long-term survival, despite her high risk for hepatic cancer relapse.

Key words
advanced gallbladder carcinoma, hepatic metastasis, adjuvant chemotherapy

Reprint requests
Osamu Ishikawa Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases 1-3-3 Nakamichi, Higashinari-ku, Osaka, 537-8511 JAPAN

Accepted
January 22, 2003

To read the PDF file you will need Abobe Reader installed on your computer.