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Kounami N, Maeda S, Kitagawa A, Tomihara H, Ushimaru Y, Ohara N, Takeoka T, Imasato M, Kawabata R, Noura S, Yasuhara Y, Miyamoto A. Early detection of occupational cholangiocarcinoma in a high-risk patient under intensive surveillance: a case study. Surg Case Rep 2024; 10:68. [PMID: 38514507 PMCID: PMC10957861 DOI: 10.1186/s40792-024-01871-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/15/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Occupational cholangiocarcinoma is associated with exposure to organic solvents, such as dichloromethane (DCM) and 1,2-dichloropropane (DCP). This report describes a case of occupational cholangiocarcinoma detected through regularly imaging following the discovery of elevated serum γ-glutamyl trans peptidase (γ-GTP) levels revealed during regular checkup. CASE PRESENTATION A 43-year-old man who had been working in a printing company with 15 years of exposure to organic solvents presented to our hospital owing to abnormalities found during a routine checkup. Ultrasound (US) imaging revealed thickening of the gallbladder wall accompanied by gallstones, although in the blood tests, γ-GTP levels were within normal range. Given the high risk of cholangiocarcinoma development, the patient underwent regular monitoring with abdominal US and blood tests at a local doctor's office. At the age of 48, his serum γ-GTP level mildly elevated for the first time, prompting the initiation of semi-annual magnetic resonance cholangiopancreatography (MRCP). By the age of 50 years, dilation in B8 was detected, and one and a half years later, a tumor on the central side of the B8 dilation appeared. The patient was diagnosed with intrahepatic cholangiocarcinoma, which was treated with anterior sectionectomy. Pathological examination revealed an adenocarcinoma with a papillary glandular ductal structure at the root of the B8. In addition, biliary intraepithelial neoplasia (BilIN) and dysplasia have been identified around the tumor and periphery bile ducts and in noncancerous bile ducts. Postoperatively, the patient received 6 months of adjuvant chemotherapy with S-1monotherapy. Eight months after surgery, the patient remained under observation with no signs of recurrence. CONCLUSIONS We report a case of occupational cholangiocarcinoma detected during a prolonged period of regular follow-up after exposure to DCM and DCP. Given the delayed carcinogenesis process, occupational cholangiocarcinomas manifest long after exposure to organic solvents, therefore, ongoing screening is extremely important. Vigilance is essential to avoid underdiagnosis, particularly for individuals who are at an increased risk of developing this form of cancer. Continuous monitoring is key to the early detection and effective management of occupational cholangiocarcinoma.
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Affiliation(s)
- Naoko Kounami
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan
| | - Sakae Maeda
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan.
| | - Akihiro Kitagawa
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan
| | - Hideo Tomihara
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan
| | - Yuki Ushimaru
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan
| | - Nobuyoshi Ohara
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan
| | - Tomohira Takeoka
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan
| | - Mitsunobu Imasato
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan
| | - Ryohei Kawabata
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan
| | - Shingo Noura
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan
| | - Yumiko Yasuhara
- Department of Pathology, Sakai City Medical Center, 1-1-1, Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan
| | - Atsushi Miyamoto
- Department of Surgery, Sakai City Medical Center, 1-1-1 Ebarazi-Cho, Nishi-Ku, Sakai, Osaka, Japan
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Kounami N, Ohara N, Imasato M, Noura S, Ushimaru Y, Kitagawa A, Tomihara H, Maeda S, Kawabata R, Miyamoto A. [A Case of Locally Advanced Giant Sigmoid Colon Cancer Successfully Treated with Neoadjuvant Chemotherapy]. Gan To Kagaku Ryoho 2023; 50:1471-1473. [PMID: 38303311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
A 51-year-old woman presented to our hospital complaining of a lower abdominal mass and dysuria. She was diagnosed with advanced sigmoid colon cancer. The tumor was large, involving the bladder, and occupying the pelvic cavity. She received neoadjuvant chemotherapy with 4 courses of mFOLFOX6, in addition to panitumumab. The treatment resulted in a marked reduction of the tumor. A laparoscopic sigmoid colon resection, total cystectomy, neobladder reconstruction, complete uterine and bilateral adnexa resection and partial ileal resection were performed. The histopathological diagnosis was ypT4b(bladder), ypN0, ypStage Ⅱc, all with negative surgical margins. Adjuvant chemotherapy was not administered owing to the patient's refusal. She remained recurrence-free for 3 years of postoperative follow up.
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