PMC6170206_01
CT images at admission.. Computed tomography (CT) showed two low-density masses of 68 mm in diameter in hepatic segments 2 and 3 and 72 mm in diameter in segment 8 as the main loci. These tumors were diagnosed as intrahepatic cholangiocarcinoma and were suspected to invade the right Glisson's sheath (blue triangle) with multiple intrahepatic metastases (red triangles).
gr1.jpg
PMC6170206_01_gr1.jpg
fig0005
These tumors were clinically diagnosed as ICC and were suspected to invade the right Glisson's sheath with multiple intrahepatic metastases classed as stage IVA according to the TMN classification, and were deemed initially unresectable (Fig. 1, Fig. 2).
Changes in tumor markers following multimodal therapy.. After two rounds of DEB-TACE with epirubicin and AS, tumor markers decreased to 20% of the initial level. After the systemic chemotherapy with gemcitabine and S1, the tumor markers decreased to just above the normal range.
gr3.jpg
PMC6170206_01_gr3.jpg
fig0015
After hepatic arterial chemoembolization therapy with drug-eluting beads (DEB-TACE), angiographic-subsegmentectomy (AS) and systemic chemotherapy with Gemcitabine and S1 were performed, tumor shrinkage was confirmed, and the tumor markers decreased to just above the normal range (Fig. 3).
CT images after multimodal therapy.. CT images revealed tumor shrinkage and disappearance of the invasion to the right Glisson's sheath and of the intrahepatic metastases.
gr4.jpg
PMC6170206_01_gr4.jpg
fig0020
CT revealed that the tumor did not invade the right Glisson's sheath and the intrahepatic metastases disappeared (Fig. 4).
Operation images.. The image illustrates a left lateral segmentectomy and 8th subsegmentectomy.
gr5.jpg
PMC6170206_01_gr5.jpg
fig0025
After the simulation of hepatic resection, left lateral segmentectomy and 8th subsegmentectomy were performed (Fig. 5).
Pathological examination.. No viable neoplastic cells were present in the specimen.
gr6.jpg
PMC6170206_01_gr6.jpg
fig0030
Pathological examination after R0 resection revealed that no viable neoplastic cells remained in the specimen (Fig. 6).
Postsurgical changes in the levels of tumor markers.. Tumor marker levels decreased to within the normal range after surgery.
gr7.jpg
PMC6170206_01_gr7.jpg
fig0035
Two years and 10 months after the surgery, the patient is alive without relapse (Fig. 7).