PMC5442343_01
Dynamic contrast-enhanced computed tomography (CT) scans showed multiple masses in the patient's liver, suggesting intrahepatic cholangiocarcinoma (ICC; (a), arrow). His liver tumors showed an enhancement of the peripheral zone in the early phase ((b), arrow) and a low intake in the hepatobiliary phase ((c), arrow) in a gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid- (Gd-EOB-DTPA-) enhanced magnetic resonance imaging (MRI).
CRIE2017-7012520.001.jpg
PMC5442343_01_CRIE2017-7012520.001.jpg
fig1
These masses showed an enhancement of the peripheral zone in the early phase of CT; the inside of such masses gradually became enhanced, suggesting an ICC with intrahepatic metastases (Figure 1(a)). T1-weighted image and a slightly high signal intensity on a T2-weighted image. These tumors showed an enhancement of the peripheral zone in the early phase and low intake of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid- (Gd-EOB-DTPA-) enhanced MRI in the hepatobiliary phase (Figures 1(b) and 1(c)).
Esophagogastroduodenoscopy revealed an infiltrative ulcerative carcinoma (arrow) in the anterior wall of the antrum of the patient's stomach.
CRIE2017-7012520.002.jpg
PMC5442343_01_CRIE2017-7012520.002.jpg
fig2
Esophagogastroduodenoscopy revealed an infiltrative ulcerative carcinoma in the anterior wall of the antrum of the patient's stomach (Figure 2).
Histological examination of an ICC (a, d), gastric cancer (GC; (b, e)), and normal hepatocyte (c, f). Hematoxylin and eosin staining (x400) of an ICC (a), an adenocarcinoma suggesting GC (b), and normal hepatocyte (c). Immunohistochemical staining by anti-PTHrP antibody (H-137; Santa Cruz Biotechnology) in an ICC (d), GC (e), and normal hepatocyte (f).
CRIE2017-7012520.003.jpg
PMC5442343_01_CRIE2017-7012520.003.jpg
fig3
ICC (Figure 3(a)). Immunohistochemically, ICC tumor cells were positive for cytokeratin 7 and PTHrP (Figure 3(d)) and negative for cytokeratin 20, CDX2, and CA19-9. A histological examination of a biopsy specimen from the GC revealed an adenocarcinoma (Figure 3(b)). Immunohistochemically, GC tumor cells were positive for cytokeratin 7, cytokeratin 20, CDX2, and CA19-9 and were negative for PTHrP (Figure 3(e)).
The corrected serum Ca level was stable without bisphosphonate after the patient commenced chemotherapy with cisplatin (CDDP) and gemcitabine (GEM).
CRIE2017-7012520.004.jpg
PMC5442343_01_CRIE2017-7012520.004.jpg
fig4
Subsequently, his corrected calcium level was kept under 11 mg/dL without using elcatonin and bisphosphonate (Figure 4).
CT scans showed that the patient's liver tumors (arrows) were reduced by the 78th (a) and 238th day (b) of admission after chemotherapy with CDDP and GEM.
CRIE2017-7012520.005.jpg
PMC5442343_01_CRIE2017-7012520.005.jpg
fig5
On the 78th day, his liver tumors were reduced (Figure 5(a)). Moreover, on the 238th day, his liver tumors were smaller than tumors observed on the 78th day (Figure 5(b)).
Esophagogastroduodenoscopy showed that the patient's gastric cancer (arrow) was reduced on the 273rd day.
CRIE2017-7012520.006.jpg
PMC5442343_01_CRIE2017-7012520.006.jpg
fig6
In addition, the volume of his gastric cancer was also decreased on the 273rd day (Figure 6), suggesting that chemotherapy with CDDP and GEM was also effective for his gastric cancer.