WCIM 2014 SEOUL KOREA 573
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0987 Pancreatobiliary
Successful Xenograft of Endoscopic Ultrasound- Guided Fine Needle Aspiration Specimen from Human Extrahepatic Cholangiocarcinoma into an Immunodefi cient Mouse
Se Young Jang1, Han Ik Bae2, In Kyu Lee1, Hwan Ki Park3, Chang-Min Cho1 Department of Internal Medicine, Kyungpook National University School of Medicine, Korea1, Depart- ment of Pathology, Kyungpook National University School of Medicine, Korea2, Leading-edge Research Center for Drug Discovery and Development for Diabetes and Metabolic Disease (DMRC), Kyungpook National University Hospital, Korea3
Introduction: Patient-derived tumor xenograft (PDTX) is the transfer of primary hu- man tumors directly into an immunodefi cient mouse. PDTX plays an important role in the development and the evaluation of a new chemotherapeutic agent. We success- fully engrafted a human biliary tumor to an athymic nude mouse.
Case Report: A 65-year old man who had previously been healthy was transferred to our clinic with complaint of jaundice for 2 weeks. He had laboratory tests and a contrast enhanced abdominal computed tomography scan. Those tests showed hyperbilirubinemia and an enhancing mass at distal common bile duct. Endoscopic ultrasound examination revealed a round mass and we did a diagnostic needle aspi- ration. Specimens were prepared for cytopathologic diagnosis and used for xenograft.
The mixture of tumor tissue-Matrigel was implanted subcutaneously into the fl ank of a 6-week-old female BALB/c-nu mouse. After 6.5 months, a 1.3 cm3 tumor was removed and analyzed. Histologic and immunohistochemical staining of the xenograft tumor demonstrated identical pathologic patterns to that of the human tumor.
Discussion: PDTX have been established and are increasingly used for preclinical stud- ies of chemotherapeutic responses. However, PDTX models for cholangiocarcinoma are relatively few in number and limited in their degree of genetic characterization and validation. This case report of a successful PDTX from bile duct cancer seems to be the fi rst for bile duct cancer, and the fi rst use of an EUS-FNA specimen. We might be able to find surrogate biomarkers predicting responses to the chemotherapeutic agents from human cancer tissues derived from patients that still have the molecular charac- teristics of the tumor. We expect to use the PDTX of bile duct cancer to contribute to tailored therapy in the future.
PS 0988 Pancreatobiliary
Steroid Challenge Test is Useful for Diagnosis of Prolonged Cholestasis After Ercp Stone Removal
Jin Kyeong Cho1, Jun Yong Bae1, Hye Won Park1, Ji Hwan Lim1, Jang Eon Kim1, Bong Roung Kim1, Yoo Hyun Jang1, Kye Heui Lee1
Seoul Medical Center, Korea1
Introduction: After successful common bile duct (CBD) stone removal by endoscopic retrograde cholangiopancreatography (ERCP), prolonged jaundice is very confused for the next decision (ERCP for remnant stone or other causes). With assurance of removal of CBD stone and no remnant stone, Liver biopsy may be useful for jaundice of parenchymal origin but invasive. In such cases, steroid challenge test is useful both diagnosis and treatment.
Case description: A 62-year-old male presented with colicky right upper quadrant pain. Laboratory tests showed total bilirubin of 7.6mg/dL, aspartate aminotransferase (AST) 60IU/L , alanine aminotransferase (ALT) 15IU/L, alkaline phosphatase (ALP) 60IU/
L and gamma-glutamyltranspeptidase (γ-GT) 71IU/L. At abdomen CT, There was single 1.3cm sized distal CBD stone and diffuse dilatation of upstream bile duct and cystic duct. The patient underwent endoscopic retrograde biliary drainage (ERBD) by plastic stent because of long procedure time for cannulation. But 5 days after the ERBD, his total bilirubin increased to 18.7mg/dL. A second ERCP was carried out, which revealed patent biliary stent and CBD stone was removed successfully. After 2 days of second ERCP, total bilirubin level increased to 19.5mg/dL. At second abdomen CT, there was no remnant stone. It was presumed that intrahepatic cholestasis was occurred by intrahepatic bile duct infl ammation from contrast agent or pethidine. Prednisolone was started (30 mg/day) for three days, which caused a signifi cant improvement of jaundice and bilirubin level. But 7 days later, his bilirubin raised up to 20.3mg/dL. It was certain that prednisolone improved his cholestasis. Prednisolone started again and after use of 30mg/day of prednisolone for 7 days, total bilirubin fell to 10mg/dL, and his jaundice was progressively declined. Steroid was used and tapered off during a month. He had normal bilirubin level and normal liver function tests.
PS 0989 Pancreatobiliary
Ceftriaxone-Induced Acute Pancreatitis in an Adult Patient
Sun-Mi Kang1, Chang Hyeong Lee1, Byung Seok Kim1, Joon Seok Park1 Department of Internal Medicine, Catholic University of Daegu School of Medicine, Korea1
Acute pancreatitis is extremely rare complication in patients treated with ceftriaxone.
It was very rarely reported and we could fi nd only 5 cases at Pubmed. Ceftriaxone may precipitate in the bile, and that may lead formation of biliary sludge. Acute pan- creatitis, cholangitis and cholecystitis may caused by biliary sludge. We experienced one case of acute pancreatitis which is developed after administration of ceftriaxone.
A 70 year-old male presented to the emergency room with drowsy mentality and fe- ver. He underwent open cholecystectomy 10 years ago. He was diagnosed liver abscess and treated with intravenous ceftriaxone (2g, once a day) and metronidazole (500 mg, three times a day). Initial computed tomography revealed liver abscess and peri- ampullary diverticulum. And there was no dilatation of bile duct and biliary sludge. 16 days after the fi rst administration of ceftriaxone, he appealed dyspepsia and epigastric pain. Follow-up CT demonstrated pancreas swelling, peripancreatic fl uid collection, common bile duct dilatation and biliary sludge at distal common bile duct. Laboratory examination showed elevated serum amylase, lipase (272.2U/L, 279.9U/L) and leuko- cytosis (mm³). Hepatobiliary ultrasonography was performed and there showed mild dilatation of common bile duct. Because the patient was obese, biliary sludge was not seen on ultrasonography. Ceftriaxone-induced pancreatitis was considered, therefore ceftriaxone was immediately discontinued. 2 days after the discontinuance of ceftri- axone, laboratory examination showed normal serum amylase and lipase and symptom was subsided. 2 weeks after the discontinuance of ceftriaxone, leukocytosis has been normalized. Ceftriaxone-induced acute pancreatitis is extremely rare, but we have to aware of the complication, because sometimes it results in severe pancreatitis.
PS 0990 Pancreatobiliary
Grave Clinical Course of Pancreatic Invasive Carcinoma Derived from Branch Duct-Type Ipmn: A Case Series
Joo Young Lee1, Ki Bae Kim1, Mi Jin Kim1, Jae Geun Park1, Joung-Ho Han1, Soon Man Yoon1, Hee Bok Chae1, Seon Mee Park1, Sei Jin Youn1
Chungbuk National University Hospital, Korea1
Branch duct intraductal papillary mucinous neoplasms of the pancreas (BD-IPMN) showed good prognosis. However, invasive carcinoma is more aggressive than that derived from main duct-type IPMN, once invasive morphological change takes place.
We report three patients with invasive carcinoma derived from BD-IPMN who showed grave clinical courses. The patients’ medical records and image studies were retrospec- tively analyzed based on clinical symptoms, biochemical data, and hospital courses. All patients were diagnosed as BD-IPMN without any malignant stigmata by MRCP, EUS, or abdominal CT scan at the initial diagnosis. Invasive ductal adenocarcinoma was detected at 3.2, 3.6, and 4.1 years later in each patient. All patients showed locally advanced invasive ductal adenocarcinoma and pathologic diagnosis was done by EUS- FNA in 2 patients and brush cytology by ERCP in one patient. All patients were treated with only conservative management and they died at 2, 3, and 6 months after the diagnosis of invasive ductal adenocarcinoma. Further studies are needed about proper follow up interval and identifi cation of risk factors in the patients with BD-IPMN of the pancreas. Metachronous or transformed invasive ductal carcinoma from BD-IPMN are not rare and they showed aggressive clinical course.
