title: Intrahepatic cholangiocarcinoma detected by elevated levels of alpha-fetoprotein-L3 after hepatectomy for hepatocellular carcinoma in a patient with Budd-Chiari syndrome.
abstract: We report the case of a 57-year-old woman with Budd-Chiari syndrome, hepatocellular carcinoma (HCC), and intrahepatic cholangiocarcinoma (ICC). She underwent partial hepatectomy for HCC in April 2000. After surgery, alpha-fetoprotein (AFP) and protein induced by vitamin K absence II (PIVKA-II) returned to normal levels, but lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3) increased, and ultrasonography showed a nodule 2 cm in greatest dimension in the left lateral segment of the liver. We diagnosed this nodule as recurrence from HCC and performed a partial hepatectomy in October 2001. Microscopic examination showed that tubular adenocarcinoma and immunohistochemical staining was focally positive for AFP. AFP-L3 was 0% and AFP was 5 ng/ml 3 months after re-operation. This case was interesting in that ICC was detected by elevated levels of AFP-L3, and ICC produced AFP from the time it was minute in size.
authors.affiliation: Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. m-yama@jg7.so-net.ne.jp
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Takehito
authors.initials: T
authors.lastname: Otsubo
authors.forename: Shunichi
authors.initials: S
authors.lastname: Ariizumi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Nakano
authors.forename: Ken
authors.initials: K
authors.lastname: Takasaki
mesh_terms: D001650:Bile Duct Neoplasms / Q000097:blood* / Q000209:etiology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D006502:Budd-Chiari Syndrome / Q000150:complications / Q000175:diagnosis; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000097:blood* / Q000209:etiology / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins