Successful treatment of gallbladder carcinoma producing alpha-fetoprotein with segmental adenomyomatosis

Abstract

Abstract:The successful treatment of hepatoid adenocarcinoma of the gallbladder with elevated serum alpha-fetoprotein (1243ng/ml) and segmental adenomyomatosis in a 58-year-old woman is described. The woman had alphafetoprotein (AFP)-producing carcinoma of the gallbladder with regional lymph node metastasis and was treated by extended radical resection and postoperative adjuvant chemotherapy. She is alive, showing normal serum AFP concentration and no recurrence, 57 months after surgery. The tumor cells were stained immunohistochemically for AFP by the peroxidase anti-peroxidase method. Serum AFP reactivity to concanavalin A and lentil lectin was similar to the pattern shown in hepatocellular carcinoma. Only a few cases of AFP-producing gallbladder carcinoma have been reported and there have been no reports of long-term survivors. The combination of aggressive radical resection and chemotherapy seems to have been effective for achieving long-term survival without liver metastasis.

Long-term survival of patients with biliary tract cancers with lymph node involvement

“…Metastatic nodes were located at and limited to the main lymphatic pathway in the tumors of 11 long‐term survivors. Two long‐term survivors with multiple lymph node metastases spreading widely around the head of the pancreas beyond the hepatoduodenal ligament have been reported previously by Tsukada et al8,9 They were treated by systemic chemotherapy, in one as the adjuvant therapy, and in the other for lymph nodal relapse with Virchow's metastasis proven microscopically. However, it appears difficult to make a precise diagnosis of lymph node metastasis during surgery.…”

“…The remaining 2 patients had seven and eight positive nodes, respectively, located around the head of pancreas. These 2 long‐term survivors both underwent pancreatoduodenectomy for multiple nodal disease8,9 and are still alive without any recurrence more than 7 years after surgery. Four of the 15 long‐term survivors died within the follow‐up period, 2 of whom died of recurrent disease.…”