Abstract
A 66-year-old man underwent pylorus-preserving pancreaticoduodenectomy (PPPD-III a) for common bile duct carcinoma after ENBD for reduction of jaundice. Six months later, multiple liver metastases were detected by abdominal CT scan. Hepatic arterial infusion chemotherapy (HAI) with 5FU 400 mg, MMC 16 mg, Epirubicin 48 mg bolus injection/20minutes was performed with minimal side effects. Liver metastases were regressed completely in CT scan and the level of CA19-9 was normalized after three times (at two-month intervals) of HAI.
He was admitted with pancytopenia (WBC3300/mm3, RBC2.26×104, Hb7.6g/dl, 4.7×104/mm3) after 19 months complete regression of multiple liver metastases by HAI. On admission, no bleeding spot could be detected by gastroscopy or colonoscopy. Bone marrow aspiration revealed acute myeloid leukemia. Chromosomal anomalies were classified as Type I secondary leukemia, which is often induced by alkylating agents. Because he was old, hematopoietic stem cell transplant or other chemotherapy was not indicated. He died 10 months after onset of leukemia. Chromosomal anomalies induced by chemotherapeutic agents for gastrointestinal malignancies may cause second malignancies.
