内容紹介
Gallbladder Cancer with Elevated Serum α-Fetoprotein, α-Fetoprotein-L3, and Human Chorionic Gonadotropin Levels
Summary
A 61-year-old woman presented with fever and was diagnosed with choledocholithiasis, which was removed endoscopically. Incidentally, a markedly elevated serum α-fetoprotein(AFP)level was detected(1,951 ng/mL), but computed tomography(CT)showed only diffuse gallbladder wall thickening. Subsequently, markedly elevated serum AFP-L3 and human chorionic gonadotropin(HCG)levels were detected(99.6% and 2,867 mIU/mL, respectively). Fluorodeoxyglucose(FDG)-positron emission tomography/CT demonstrated high FDG uptake only in the gallbladder. Gallbladder cancer was suspected and the patient was scheduled for a cholecystectomy. However, CT just prior to surgery revealed multiple liver metastases. Percutaneous gallbladder biopsy revealed a moderately differentiated adenocarcinoma positive for AFP but not HCG. The patient underwent chemotherapy consisting of gemcitabine and cisplatin. A CT scan obtained 12 weeks later showed disease progression and AFP and HCG levels were found to have increased to 4,021 ng/mL and 66,000 mIU/mL, respectively. Although immunohistochemistry of biopsy specimen did not demonstrate HCG production, increased serum HCG level on disease progression definitely suggested HCG production of gallbladder cancer. We believe the biopsy specimen was very small and therefore did not prove HCG production. Gallbladder cancer with simultaneous production of AFP and HCG is rare, and we therefore report this case together with a review of the literature.
要旨
患者は61歳,女性。IgG4関連硬化性胆管炎にてプレドニゾロン5 mgで維持療法中であった。発熱により来院。総胆管結石・胆管炎と診断し,結石は内視鏡的に除去,胆管炎は改善した。その際のCTおよび超音波にて,胆嚢壁肥厚と内腔の不明瞭化を認めた。血清α-fetoprotein(AFP),AFP-L3およびhuman chorionic gonadotropin(HCG)の著増を認めた。FDG-PET/CTでは胆嚢のみに取り込みを認めた。胆嚢癌の疑いにて手術を予定したが,肝転移が出現。経皮的胆嚢生検では中分化腺癌であった。免疫染色ではAFP陽性,HCG陰性であった。しかし,臨床経過からはAFPおよびHCG産生胆嚢癌と考えられた。AFPおよびHCG産生胆嚢癌はまれであり,文献的考察を含めて報告する。
目次
Summary
A 61-year-old woman presented with fever and was diagnosed with choledocholithiasis, which was removed endoscopically. Incidentally, a markedly elevated serum α-fetoprotein(AFP)level was detected(1,951 ng/mL), but computed tomography(CT)showed only diffuse gallbladder wall thickening. Subsequently, markedly elevated serum AFP-L3 and human chorionic gonadotropin(HCG)levels were detected(99.6% and 2,867 mIU/mL, respectively). Fluorodeoxyglucose(FDG)-positron emission tomography/CT demonstrated high FDG uptake only in the gallbladder. Gallbladder cancer was suspected and the patient was scheduled for a cholecystectomy. However, CT just prior to surgery revealed multiple liver metastases. Percutaneous gallbladder biopsy revealed a moderately differentiated adenocarcinoma positive for AFP but not HCG. The patient underwent chemotherapy consisting of gemcitabine and cisplatin. A CT scan obtained 12 weeks later showed disease progression and AFP and HCG levels were found to have increased to 4,021 ng/mL and 66,000 mIU/mL, respectively. Although immunohistochemistry of biopsy specimen did not demonstrate HCG production, increased serum HCG level on disease progression definitely suggested HCG production of gallbladder cancer. We believe the biopsy specimen was very small and therefore did not prove HCG production. Gallbladder cancer with simultaneous production of AFP and HCG is rare, and we therefore report this case together with a review of the literature.
要旨
患者は61歳,女性。IgG4関連硬化性胆管炎にてプレドニゾロン5 mgで維持療法中であった。発熱により来院。総胆管結石・胆管炎と診断し,結石は内視鏡的に除去,胆管炎は改善した。その際のCTおよび超音波にて,胆嚢壁肥厚と内腔の不明瞭化を認めた。血清α-fetoprotein(AFP),AFP-L3およびhuman chorionic gonadotropin(HCG)の著増を認めた。FDG-PET/CTでは胆嚢のみに取り込みを認めた。胆嚢癌の疑いにて手術を予定したが,肝転移が出現。経皮的胆嚢生検では中分化腺癌であった。免疫染色ではAFP陽性,HCG陰性であった。しかし,臨床経過からはAFPおよびHCG産生胆嚢癌と考えられた。AFPおよびHCG産生胆嚢癌はまれであり,文献的考察を含めて報告する。