Fever as Initial Symptom of Intrahepatic Cholangiocellular Carcinoma: Report of 4 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHAORong-rong ¹ , YUZe-yuan ² ,  CHENHong ¹

1. Department of Infectious Disease, The First Hospital of Lanzhou University, Lanzhou 730030, Gansu Province, China;
2. Department of General Surgery, The Second Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China;

Corresponding author：

CHENHong, Email: chenhong1956@126.com

Keywords：

Intrahepatic cholangiocellular carcinoma; Fever; Liver area pain; Hepatitis B; Pathological biopsy

DOI：

10.7507/1007-9424.20150390

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To discuss clinical manifestation, laboratory examination, imaging and pathological features of intrahepatic cholangiocellular carcinoma(ICC) patients with fever as initial symptom accompanied with liver area pain, in order to improve the clinicians' acquaintance for ICC under similar circumstances. Method The case informations including medical history, clinical manifestation, laboratory examination, imaging finding, pathological examination, and treatment of 4 patients diagnosed with ICC by pathological biopsy from july 2013 to October 2014 in the First hospital of Lanzhou University were analyzed retrospectively. Results All of four cases showed the fever as the initial symptom accompanied with the liver area pain. All of them had got chronic HBV infection. The WBC, neutrophil percentage, and procalcitonin were increased on admission in 3 cases. the levels of serum ALP and GGT were elevated in 3 patients. The AFP was obviously increased in 1 patient. The serum CA19-9 had moderately elevated in 2 patients. the ferroprotein was obviously increased in 2 patients. All the patients were confirmed under the abdominal CT scans and the liver pathological biopsy. Conclusion Patients with fever and liver area pain as intial symptoms, and with chronic hepatitis B and space-occupying lesions, who should be alert for ICC.

Citation： ZHAORong-rong, YUZe-yuan, CHENHong. Fever as Initial Symptom of Intrahepatic Cholangiocellular Carcinoma: Report of 4 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(12): 1501-1506. doi: 10.7507/1007-9424.20150390 Copy

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2.	Casavilla FA, Marsh JW, Iwatsuki S, et al. Hepatic resection and transplantation for peripheral cholangiocarcinoma. J Am Coll Surg, 1997, 185(5): 429-436.
3.	Poultsides GA, Zhu AX, Choti MA, et al. Intrahepatic cholangiocar-cinoma. J Surg Clin North Am, 2010, 90(4): 817-837.
4.	Witjes CD, Karim-Kos HE, Visser O, et al. Intrahepatic cholangio-carcinoma in a low endemic area: rising incidence and improved survival. HPB (Oxford), 2012, 14 (11): 777-781.
5.	Lim JH. Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol, 2003, 181(3): 819-827.
6.	Tyson GL, El-Serag HB. Risk factors for cholangiocarcinoma. Hepa-tology, 2011, 54(1): 173-184.
7.	Palmer WC, Patel T. Are common factors involved in the pathogen-esis of primary liver cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma. J Hepatol, 2012, 57(1): 69-76.
8.	袁磊, 罗贤武, 王义.肝内胆管细胞癌发病机制研究进展.肝胆外科杂志, 2013, 21(5): 389-391.
9.	Fava G, Marzioni M, Benedetti A, et al. Molecular pathology of biliary tract cancers. Cancer Lett, 2007, 250(2): 155-167.
10.	Ben-Menachem T. Risk factors for cholangiocarcinoma. Eur J Gastroenterol Hepatol, 2007, 19(8): 615-617.
11.	Mosconi S, Beretta GD, Labianca R, et al. Cholangiocarcinoma. Crit Rev Oncol Hematol, 2009, 69(3): 259-270.
12.	Welzel TM, Graubard BI, El-Serag HB, et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma in the United States: a population-based case-control study. Clin Gastroenterol Hepatol, 2007, 5(10): 1221-1228.
13.	Kobayashi M, Ikeda K, Saitoh S, et al. Incidence of primary cholan-giocellular carcinoma of the liver in Japanese patients with hepatitis C virus-related cirrhosis. Cancer, 2000, 88(11): 2471-2477.
14.	Shaib YH, El-Serag HB, Davila JA, et al. Risk factors of intrahepatic cholangiocarcinoma in the United States: a case-control study. Gastroenterology, 2005, 128(3): 620-626.
15.	Liang X, Bi S, Yang W, et al. Evaluation of the impact of hepatitis B vaccination among children born during 1992-2005 in China. J Infect Dis, 2009, 200(1): 39-47.
16.	Liang X, Bi S, Yang W, et al. Epidemiological serosurvey of hepatitis B in China-declining HBV prevalence due to hepatitis B vaccina-tion. Vaccine, 2009, 27(47): 6550-6557.
17.	路利军, 李鹏, 雷小艳, 等.肝内胆管细胞癌的螺旋CT诊断.中国临床研究, 2011, 24(9): 818-819.
18.	Olnes MJ, Erlich R. A review and update on cholangiocarcinoma. Oncology, 2004, 66(3): 167-179.
19.	Nehls O, Gregor M, Klump B. Serum and bile markers for cholang-iocarcinoma. Semin Liver Dis, 2004, 24(2): 139-154.
20.	Kalambokis G, Kostoula A, Economou M, et al. Tumor necrosis factor-alpha-related intraperitoneal release of CA 125 in cirrhotic patients with sterile ascites. Clin Chem, 2005, 51(11): 2207-2208.
21.	肖文斌, 刘玉兰.肝硬化患者血清和腹水CA125升高.世界华人消化杂志, 2003, 11(11): 1720-1722.
22.	何振平, 马宽生, 王曙光, 等.肝内胆管癌的临床病理特征与外科治疗.中华肝胆外科杂志, 2002, 8(8): 475-477.
23.	Peng NF, Li LQ, Qin X, et al. Evaluation of risk factors and clinico-pathologic features for intrahepatic cholangiocarcinoma in Southern China: a possible role of hepatitis B virus. Ann Surg Oncol, 2011, 18(5): 1258-1266.
24.	Yu TH, Yuan RH, Chen YL, et al. Viral hepatitis is associated with intrahepatic cholangiocarcinoma with cholangiolar differentiation and N-cadherin expression. Mod Pathol, 2011, 24(6): 810-819.
25.	Ishikawa K, Sasaki A, Haraguchi N, et al. A case of an alpha-fetoprotein-producing intrahepatic cholangiocarcinoma suggests probable cancer stem cell origin. Oncologist, 2007, 12(3): 320-324.
26.	郭琪, 袁知东.肝内胆管细胞癌的MSCT诊断价值.中国CT和MRI杂志, 2010, 8(2): 25-27.
27.	Maetani Y, Itoh K, Watanabe C, et al. MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation. AJR Am J Roent-genol, 2001, 176(6): 1499-1507.

1. Zhou YM, Yin ZF, Yang JM, et al. Risk factors for intrahepatic cholangiocarcinoma: a case-control study in China. World J Gastroen-terol, 2008, 14(4): 632-635.
2. Casavilla FA, Marsh JW, Iwatsuki S, et al. Hepatic resection and transplantation for peripheral cholangiocarcinoma. J Am Coll Surg, 1997, 185(5): 429-436.
3. Poultsides GA, Zhu AX, Choti MA, et al. Intrahepatic cholangiocar-cinoma. J Surg Clin North Am, 2010, 90(4): 817-837.
4. Witjes CD, Karim-Kos HE, Visser O, et al. Intrahepatic cholangio-carcinoma in a low endemic area: rising incidence and improved survival. HPB (Oxford), 2012, 14 (11): 777-781.
5. Lim JH. Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol, 2003, 181(3): 819-827.
6. Tyson GL, El-Serag HB. Risk factors for cholangiocarcinoma. Hepa-tology, 2011, 54(1): 173-184.
7. Palmer WC, Patel T. Are common factors involved in the pathogen-esis of primary liver cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma. J Hepatol, 2012, 57(1): 69-76.
8. 袁磊, 罗贤武, 王义.肝内胆管细胞癌发病机制研究进展.肝胆外科杂志, 2013, 21(5): 389-391.
9. Fava G, Marzioni M, Benedetti A, et al. Molecular pathology of biliary tract cancers. Cancer Lett, 2007, 250(2): 155-167.
10. Ben-Menachem T. Risk factors for cholangiocarcinoma. Eur J Gastroenterol Hepatol, 2007, 19(8): 615-617.
11. Mosconi S, Beretta GD, Labianca R, et al. Cholangiocarcinoma. Crit Rev Oncol Hematol, 2009, 69(3): 259-270.
12. Welzel TM, Graubard BI, El-Serag HB, et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma in the United States: a population-based case-control study. Clin Gastroenterol Hepatol, 2007, 5(10): 1221-1228.
13. Kobayashi M, Ikeda K, Saitoh S, et al. Incidence of primary cholan-giocellular carcinoma of the liver in Japanese patients with hepatitis C virus-related cirrhosis. Cancer, 2000, 88(11): 2471-2477.
14. Shaib YH, El-Serag HB, Davila JA, et al. Risk factors of intrahepatic cholangiocarcinoma in the United States: a case-control study. Gastroenterology, 2005, 128(3): 620-626.
15. Liang X, Bi S, Yang W, et al. Evaluation of the impact of hepatitis B vaccination among children born during 1992-2005 in China. J Infect Dis, 2009, 200(1): 39-47.
16. Liang X, Bi S, Yang W, et al. Epidemiological serosurvey of hepatitis B in China-declining HBV prevalence due to hepatitis B vaccina-tion. Vaccine, 2009, 27(47): 6550-6557.
17. 路利军, 李鹏, 雷小艳, 等.肝内胆管细胞癌的螺旋CT诊断.中国临床研究, 2011, 24(9): 818-819.
18. Olnes MJ, Erlich R. A review and update on cholangiocarcinoma. Oncology, 2004, 66(3): 167-179.
19. Nehls O, Gregor M, Klump B. Serum and bile markers for cholang-iocarcinoma. Semin Liver Dis, 2004, 24(2): 139-154.
20. Kalambokis G, Kostoula A, Economou M, et al. Tumor necrosis factor-alpha-related intraperitoneal release of CA 125 in cirrhotic patients with sterile ascites. Clin Chem, 2005, 51(11): 2207-2208.
21. 肖文斌, 刘玉兰.肝硬化患者血清和腹水CA125升高.世界华人消化杂志, 2003, 11(11): 1720-1722.
22. 何振平, 马宽生, 王曙光, 等.肝内胆管癌的临床病理特征与外科治疗.中华肝胆外科杂志, 2002, 8(8): 475-477.
23. Peng NF, Li LQ, Qin X, et al. Evaluation of risk factors and clinico-pathologic features for intrahepatic cholangiocarcinoma in Southern China: a possible role of hepatitis B virus. Ann Surg Oncol, 2011, 18(5): 1258-1266.
24. Yu TH, Yuan RH, Chen YL, et al. Viral hepatitis is associated with intrahepatic cholangiocarcinoma with cholangiolar differentiation and N-cadherin expression. Mod Pathol, 2011, 24(6): 810-819.
25. Ishikawa K, Sasaki A, Haraguchi N, et al. A case of an alpha-fetoprotein-producing intrahepatic cholangiocarcinoma suggests probable cancer stem cell origin. Oncologist, 2007, 12(3): 320-324.
26. 郭琪, 袁知东.肝内胆管细胞癌的MSCT诊断价值.中国CT和MRI杂志, 2010, 8(2): 25-27.
27. Maetani Y, Itoh K, Watanabe C, et al. MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation. AJR Am J Roent-genol, 2001, 176(6): 1499-1507.

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Fever as Initial Symptom of Intrahepatic Cholangiocellular Carcinoma: Report of 4 Cases

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