Abstract
A 67-year-old man was seen at the hospital because of right hypochondralgia and high fever. Abdominal magnetic resonance imaging revealed a tumor mainly located in the anterior segment of the liver. Subsegmentectomy, cholecystectomy, partial resection of the duodenum, and partial resection of the transverse colon were performed. The H.E. staining revealed poorly differentiated cholangiocellular carcinoma. The patient developed dry mouth, polydipsia, polyuria, general fatigue, and disorientation since around postoperative 30th day. No hyperglycemia and bone metastasis were noted, but increases in Ca and PTHrP levels (14.6 mg/ml and 7.0pmol/l, respectively) were confirmed. Immediately calcitonin and zoredronate were administered. His symptoms were alleviated with this regimen, but soon he developed disseminated metastasis and died on the 64th postoperative day. Immunohistochemically the tumor cells were positive for CEA, cytokeratin (CK)-7, CK-8, CK-19, and PTHrP, but negative for AFP, hepatocyte specific antigen (HSA), CK-20, and PTH. PTHrP producing cholangiocarcinoma was finally diagnosed.
