A case of concomitant colitic cancer and intrahepatic cholangiocarcinoma during follow-up for ulcerative colitis
Tóm tắt
Colitis-associated colorectal cancer (CAC) is known to occur in long-standing and extensive ulcerative colitis (UC). Furthermore, UC is known to complicate primary sclerosing cholangitis (PSC), which subsequently results in an increased risk of developing cholangiocarcinoma. We report a case of colitis-associated rectal cancer (CARC) accompanied by intrahepatic cholangiocarcinoma (ICC) based on UC and PSC. A 73-year-old man had suffered from UC for 19 years. During surveillance colonoscopy, a tumor was found in the rectum that was pathologically diagnosed as CARC from the resected specimen. Abdominal computed tomography also revealed a localized dilation of the intrahepatic bile duct, and endoscopic retrograde cholangiography revealed a band-like stricture. This remarkable tumor lesion was not observed in the hepatic duct. Left hepatectomy was performed because of the suspicion of possible ICC at the stenosis of the hepatic duct. The presence of ICC was confirmed at the lesion causing the stricture. The pathological diagnosis from the resected specimen was ICC based on PSC. Adjuvant chemotherapy for ICC was performed for 6 months. Neither cancer has recurred for 2.5 years after hepatectomy. Patients with PSC concomitant with UC should be considered a high-risk group for CAC and ICC.
Tài liệu tham khảo
Ikeuchi H, Uchino M. Front-line surgical therapy for ulcerative colitis. Nihon Shokakibyo Gakkai Zasshi. 2016;113:424–9.
Ekbom A, Helmick C, Zack M, et al. Ulcerative colitis and colorectal cancer. A population-based study. N Engl J Med. 1990;323:1228–33.
Itzkowittz SH, Harpaz N. Diagnosis and management of dysplasia in patients with inflammatory bowel disease. Gastroenterology. 2004;126:1634–48.
Rosen C, Nagorney DM, Wiesner RH, et al. Cholangiocarcinoma complicating primary sclerosing cholangitis. Ann Surg. 1991;213:21–5.
Yamanaka N, Okamoto E, Ando T, et al. Clinicopathologic spectrum of resected extraductal mass-forming intrahepatic cholangiocarcinoma. Cancer. 1995;76:2449–56.
Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7th ed. Oxford: Wiley-Blackwell; 2009.
Kubota Y, Muto T, Sawada T, et al. Long-standing ulcerative colitis complicating rectal cancer and bile duct carcinoma—report of a case and review of the literature. Nippon Daicho Komonbyo Gakkai Zasshi. 1986;39:28–37.
Crohn BB, Rosenberg H. The sigmoidoscopic picture of chronic ulcerative colitis (non-specific). Am J Med Sci. 1925;170:220–8.
Morson BC, Pang LS. Rectal biopsy as an aid to cancer control in ulcerative colitis. Gut. 1967;8:423–34.
Hata K, Watanabe T, Kazama S, et al. Earlier surveillance colonoscopy programme improves survival in patients with ulcerative colitis associated colorectal cancer: results of a 23-year surveillance programme in the Japanese population. Br J Cancer. 2003;89:1232–6.
Watanabe T, Konishi T, Kishimoto J, et al. Ulcerative colitis-associated colorectal cancer shows a poorer survival than sporadic colorectal cancer: a nationwide Japanese study. Inflamm Bowel Dis. 2011;17:802–8.
Van Assche G, Dignass A, Bokemeyer B, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 3: special situations. J Crohns Colitis. 2013;7:1–33.
Kobayashi S, Fujimori T, Mitomo H, et al. Immunohistochemical assessment of a unique basal pattern of p53 expression in ulcerative-colitis-associated neoplasia using computer-assisted cytometry. Diagn Pathol. 2014;9:99.
Lee YM, Kaplan MM. Primary sclerosing cholangitis. N Engl J Med. 1995;332:924–33.
Broomé U, Löfberg R, Veress B, et al. Primary sclerosing cholangitis and ulcerative colitis: evidence for increased neoplastic potential. Hepatology. 1995;22:1404–8.
Takikawa H, Takamori Y, Tanaka A, et al. Analysis of 388 cases of primary sclerosing cholangitis in Japan. Presence of a subgroup without pancreatic involvement in older patients. Hepatol Res. 2004;29:153–9.
Shetty K, Rybicki L, Brzezinski A, et al. The risk for cancer or dysplasia in ulcerative colitis patients with primary sclerosing cholangitis. Am J Gastroenterol. 1999;94:1643–9.
Uchiyama K, Yamamoto M, Yamaue H, et al. Impact of nodal involvement on surgical outcomes of intrahepatic cholangiocarcinoma: a multicenter analysis by the study group for hepatic surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci. 2011;18:443–52.
Liang B, Zhong L, He Q, et al. Diagnostic accuracy of serum CA19-9 in patients with cholangiocarcinoma: a systematic review and meta-analysis. Med Sci Monit. 2015;21:3555–63.
Cheng Q, Feng F, Zhu L, et al. Circulating miR-106a is a novel prognostic and lymph node metastasis indicator for cholangiocarcinoma. Sci Rep. 2015;5:16103.