Abstract
A 72-year-old man who was pointed out swelling of the lymph node at the superior border of the pancreas on an abdominal ultrasonography at a neighboring hospital was referred to our hospital for the purpose of close exploration and treatment. An abdominal CT scan showed a 25-mm solid tumor at the fundus of gallbladder and the swollen lymph node No.8a. Carcinoma of gallbladder was diagnosed. We performed hepatic segmentectomy (S4a+S5) with resection of bile duct, lymph node dissection, and biliary reconstruction. The final histopathological diagnosis was neuroendocrine carcinoma associated with moderately differentiated adenocarcinoma. Since the CA19-9 level was already high before surgery and the extra-regional lymph node had metastasis of adenocarcinoma component, S-1 regimen that is considered for usual type gallbladder carcinoma as adjuvant chemotherapy was started. However, abdominal CT scan performed nine months later demonstrated two abdominal lymph node metastases 15 mm in diameter. The CA19-9 level began to rise again. We thus considered that recurrence of adenocarcinoma component might occur and changed chemotherapy from the S-1 to the gemcitabine + cisplatin regimen, when the abdominal lymph nodes disappeared. No further metastasis or recurrence has occurred, as of two years after the operation.
