2016 Volume 52 Issue 7 Pages 1303-1308
Long-term survivors without liver transplantation after Kasai have the problem of hepatic cancerization. Here, we report the case of a patient who developed intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC), i.e., combined HCC type, after surgery for biliary atresia (BA). The patient was a 39-year-old male who underwent jejunal interposition hepatic portoduodenostomy for BA, I-b2-γ type, 85 days after birth. Esophageal varices appeared when he was 10 years old and worsened from 17 years of age. He had cholangitis repeatedly at 27 years of age and liver cirrhosis with ascites at 35 years of age. The tumor markers were rising and a two-pathologic-type lesion in S1 was pointed out in imaging studies; thus, he was diagnosed as having ICC and HCC (combined HCC type). Combined HCC showed T3cN0cM0 clinical stage III and liver damage C; thus, he underwent transcatheter arterial chemoembolization (TACE). HCC showed complete necrosis, but ICC showed no mass reduction; thus, we performed gemcitabine chemotherapy. Although he underwent chemotherapy with gemcitabine, the tumor size continued to increase and liver failure developed. He died 8 months after treatment. This is the only case of the combined HCC type and the oldest among all cases of hepatic cancer after surgery for BA. Because all patients with cholangiocarcinoma died after surgery, their prognosis was considered poor. In the follow up of long-term survivors without liver transplantation, it is considered that management for ICC after operation is important.
