1. Cholangiocarcinoma in HBV Non-Cirrhotic

2. 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 copies/ml
-AFP was 2.8 2

3. 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

4. 4

6. 6

7. 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

8. 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

9. 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

10. 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