De novo perihilar cholangiocarcinoma arising in the allograft liver 15 years post-transplantation for biliary atresia.

Abstract

Most primary liver cancers diagnosed in allograft livers are recurrent tumors of the native liver origin, while donor-derived primary liver cancers are markedly less common. A 21-year-old woman who had liver transplantation for post-Kasai biliary atresia was recently referred for post-transplant biliary stricture. Her transplantation was performed at the age of 6 years using the whole liver graft from a 10-year-old donor and choledocho-jejunostomy. The post-transplant course was uneventful in the first 15 years until she presented with obstructive jaundice. The stricture was located at the level of the hepaticojejunostomy, and required percutaneous transhepatic drainage and bile duct dilatation. She underwent an exploratory laparotomy, which suggested a neoplastic process widely involving the extrahepatic and intrahepatic large bile ducts. The histological examination of the resected extrahepatic bile duct confirmed infiltrating moderately differentiated adenocarcinoma. Molecular tests of multiple short tandem repeat loci confirmed the donor origin of the tumor. After four cycles of chemotherapy with gemicitabine and cisplatin, she is currently on radiotherapy in view of potential re-transplantation. De novo, post-transplant cholangiocarcinoma of graft origin is extremely uncommon with only three other cases reported. Two were associated with recurrent primary sclerosing cholangitis, and all had choledocho-jejunostomy at the time of transplantation.

• Authors: Yoh Zen, Parthi Srinivasan, Misa Kitagawa, Koichi Suzuki, Michael Heneghan, Andreas Prachalias
• Journal: Pathology international (Pathol Int) Vol. 70 Issue 8 Pg. 563-567 (Aug 2020) ISSN: 1440-1827 [Electronic] Australia
• PMID: 32350971 (Publication Type: Case Reports)
• Copyright: © 2020 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.

Chemical References

• Immunosuppressive Agents
• Deoxycytidine
• Cisplatin
• Gemcitabine

Topics

• Adenocarcinoma (diagnosis, drug therapy, pathology, radiotherapy)
• Allografts (pathology)
• Bile Duct Neoplasms (pathology)
• Biliary Atresia (surgery)
• Child
• Cholangiocarcinoma (drug therapy, pathology, radiotherapy)
• Cisplatin (therapeutic use)
• Constriction, Pathologic (pathology)
• Deoxycytidine (analogs & derivatives, therapeutic use)
• Female
• Humans
• Immunosuppressive Agents (therapeutic use)
• Liver (pathology)
• Liver Transplantation (adverse effects)
• Neoplasm Recurrence, Local (pathology)
• Postoperative Complications (pathology)
• Young Adult
• Gemcitabine