Repetitive response to gemcitabine that led to curative resection in cholangiocarcinoma

Abstract

This study reports a case of unresectable intrahepatic mass-forming cholangiocarcinoma which showed a dramatic response to gemcitabine that led to curative resection and a long-term survival of more than five years. Six and five cycles of gemcitabine monotherapy were administered separately over a three-year period and a radical excision was performed at 4.5 years after diagnosis. This case indicates the role of gemcitabine as a neoadjuvant chemotherapeutic agent for cholangiocarcinoma and guarantees a randomized controlled prospective study.

Figure 1

Abdominal CT scan images at two different levels are shown serially. A: At left portal vein level (black arrowhead), a 10 cm sized irregular hypovascular mass (asterisk) occupying left hepatic lobe is shown; B: At lower, main portal vein level (black arrow), the inferiorly grown mass is shown. Invasion of middle hepatic vein and left portal vein were strongly suggested with multiple lymph node enlargements at the liver hilum and lesser omentum; C and D: On CT scan taken after the end of the first 6 cycles (18 times) of gemcitabine chemotherapy, the tumor mass decreased in size dramatically, smaller than half of the previous diameter; E and F: On CT scan on 3 years and 3 mo from diagnosis, mass does not show any significant change except for a little sclerotic change; G and H: On CT scan on 4 years from diagnosis, tumor mass shows re-increment of the size than previous study; I and J: On follow up CT scan after second 5 cycles of gemcitabine chemotherapy, partial response is shown again with slight decrease of the mass size; K and L: On CT scan taken 11 months after R0 resection, there is no any recurrence or new lesion growing.

Figure 2

Histological finding of resected specimen is shown. Well differentiated adenocarcinoma is seen with glandular structure and a dense fibrous stroma. Scattered lymphocytes are also present (40 × magnification). In higher magnification, tumor is composed of glands lined by cuboidal mucin-producing epithelium resemble biliary epithelium ( Inset, 400 × magnification).