Hashimoto S, Sumida Y, Araki M, Wakata K, Hamada K, Niino D. Usefulness of
18F-fluorodeoxyglucose positron emission tomography for assessment of tumorviability after resection of granulocyte-colony-stimulating-factor -Producing cholangiocarcinoma-a case report.
Int J Surg Case Rep 2021;
80:105623. [PMID:
33647545 PMCID:
PMC7921818 DOI:
10.1016/j.ijscr.2021.02.009]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 11/19/2022] Open
Abstract
Surgical case of Granulocyte-Colony-Stimulating-Factor -Producing Cholangiocarcinoma is limited.
18F-fluorodeoxyglucose positron emission tomography is reported to be useful in diagnosis.
18F-fluorodeoxyglucose uptake in bone marrow is characteristic in this disease.
We used FDG uptake not only diagnosis but assessing tumor viability and determining the surgical indication after postoperative recurrence.
Introduction and importance
Granulocyte colony-stimulating factor (G-CSF)-producing intrahepatic cholangiocarcinoma is rare. Surgical cases with postoperative clinical course have rarely been reported.
Case presentation
A 63-year-old woman complained upper abdominal pain. Computed tomography (CT) showed intrahepatic mass measuring 9 × 9 × 9 cm in the left lateral segment. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed high uptake by the tumor, with diffuse uptake in the bone marrow. An extended left lobectomy was performed to achieve complete resection. Histopathological examination showed poorly differentiated adenocarcinoma with no lymph node metastasis. Immunohistochemical analysis revealed that tumor cells produced G-CSF. After chemotherapy with S-1 regimen at 10 months after the operation, CT and FDG-PET detected lymph node metastasis in the peri-duodenal area and left kidney metastasis, with no FDG uptake in the bone marrow. Serum G-CSF was normal. Combination chemotherapy with gemcitabine plus cisplatin was administered, and, 12 months after liver resection, metastases were enlarged and FDG uptake in the bone marrow was detected again. Serum G-CSF was elevated at 71.6 pg/mL. The patient was enrolled in a clinical trial of chemotherapy with another regimen and was alive at 19 months after liver resection.
Clinical discussion
Because of rapid progression, rapid diagnosis and resection are important. FDG uptake in the bone marrow is characteristic in G-CSF producing tumor. In this case, FDG uptake in the bone marrow reappeared after the enlargement of recurrent lesions, followed by tumor enlargement.
Conclusion
FDG-PET was useful for differential diagnosis and to assess tumor viability and determine the surgical indication.
Collapse