Case ReportNeoadjuvant photodynamic therapy before curative resection of proximal bile duct carcinoma
Section snippets
Case and Photodynamic Treatment
A 72-year-old Caucasian male was evaluated for obstructive cholestasis of 4 weeks duration. Seven and five years ago he had been treated for highly differentiated squamous cell carcinoma of the right tonsil, so far without evidence of tumor recurrence. On physical examination he appeared slightly icteric, without signs of chronic liver disease. The liver was non-tender and palpable 2 cm below the right costal margin; the spleen was not enlarged. He had irregular heart rate (88/min) with
Results
Twenty-two hours after administration of sodium porfimer, the adenocarcinoma exhibited 2.4-fold enrichment of porfimer-specific fluorescence as compared with the adjacent normal bile duct epithelium (Fig. 3A and B). In serial cross-sections of the surgical specimen, the wall of the tumor stenosis contained necroses with brown pigment of degraded photosensitizer and a dense inflammatory infiltrate in the inner layer within 4 mm distance from the lumen; no viable tumor cells were found in this
Discussion
Most malignant tumors of the proximal common bile duct and its bifurcation are differentiated adenocarcinomas with small tumor mass at diagnosis 1., 3.. However, only about 20% of them are suited for curative resection, and the large majority (75%–80%) recur for two reasons - lymphatic extension and multifocal extension in the bile ducts 5., 6., 7., 8., 9., 10.. The present case shows the effectiveness and limitations of photodynamic treatment with sodium porfimer and the feasibility of
Acknowledgements
The authors wish to thank Dr. Reinhold Baumgartner, Laser Center at Klinikum Großhadern of the Ludwig-Maximilians University in Munich and Dr. Maria-Anna E. J. Ortner, Klinikum Charité of the Humboldt University in Berlin for advice in technical aspects of photodynamic laser therapy.
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