Cholangiocarcinoma in HBV Non-Cirrhotic

History of Present Illness 40 Japanese M with chronic hepatitis B Examination is – ve for s/o CLD Labs showed: -Platelets of 195 -Bili 1.8 AST 554 ALT 1243 -INR 1.0 and Albumin 4.2 -HbsAg +ve, HBeAg –ve, HBeAb +ve, -HBV DNA 120000 copies/ml -AFP was 2.8 2

Course of Action/Follow-up Lamivudine initially f/b Lamivudine + Adefovir On treatment, -HBV DNA became Non-detectable -LFTs normalized Remained surface antigen positive Pt was followed with US and AFP Q6months US showed a 1 cm simple cyst in left lobe 3

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Tumor Histochemical stains: -CK7+ve, CK19+ve and CEA+ve -Hepatocellular Ag-ve and TTF-1-ve Tumor markers: -AFP was 7.6 and CA 19-9 was 4500 7

Initial Management of Tumor Down size the tumor: (12/05) -Chemoembolization with Cisplatin -Adjuvant chemo: Gemcitabine & Bevacizumab. Tumor reduced in size -From 3.9x5.0x3.3 to 3.7x3.0x4.3 -CA 19-9 went down from 4500 to 2500 8

Initial Surgery Resection of right lobe (02/06) -Margins of resection were -ve but close to it -Lymph nodes were –ve -Portal vein was not involved Post-resection: -Adjuvant Gemcitabine for 6 months -Radiation therapy was not offered 9

Follow-up Post Resection Recurrence of Tumor on PET scan (07/06) Managed with: - Resection of part of left lobe (08/06) but - Margins were +ve - 2/2 nodes were positive - Left branch of PV was occluded - Adjuvant chemo with capecitabine and oxaliplatin - Radiotherapy Patient died 4 months after tumor recurrence 10