Report of a Case; Successful Resection was Performed for Patient of Gallbladder Carcinoma who had been Untreated for 1 Year After being Detected as Massive Hepatic Involvement

A 79-year-old woman was admitted to our hospital because of left middle quadrant abdominal pain. She had been diagnosed with advanced stage gallbladder carcinoma 1 year previously. Abdominal computed tomography revealed low-density tumor, 7 cm in diameter, in the central bisegment (both segment 4 and anterior segment) of the liver, but no swollen lymph nodes or liver metastases were found. Endoscopic retrograde cholangiography demonstrated no biliary involvement except a filling defect of the body and tail of gallbladder. Hepatic arteriography showed no encasement of the right hepatic artery. Central bisegmentectomy of the liver with lymph nodes dissection (D2) were performed. Pathologically, no liver metastases, no major biliary involvement, no metastatic regional lymph nodes and no right hepatic arterial involvement were identified despite direct invasion to the parenchyma of the liver by a bulky gallbladder tumor. She had no evidence of recurrence 1 year 4 menths later. Clinically, This tumor had very slow growth potential and the doubling time of serum carbohydrate antigen 19-9 with this patient was very long. Furthermore, this tumor was suggested to have low-grade malignant potential based on immunohistochemical expression analysis of p53, K-67 and vascular endothelial growth factor.