case_images: PMC5442343_01
case_images: Dynamic contrast-enhanced computed tomography (CT) scans showed multiple masses in the patient's liver, suggesting intrahepatic cholangiocarcinoma (ICC; (a), arrow). His liver tumors showed an enhancement of the peripheral zone in the early phase ((b), arrow) and a low intake in the hepatobiliary phase ((c), arrow) in a gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid- (Gd-EOB-DTPA-) enhanced magnetic resonance imaging (MRI).
case_images: CRIE2017-7012520.001.jpg
case_images: PMC5442343_01_CRIE2017-7012520.001.jpg
case_images: fig1
case_images: These masses showed an enhancement of the peripheral zone in the early phase of CT; the inside of such masses gradually became enhanced, suggesting an ICC with intrahepatic metastases (Figure 1(a)). T1-weighted image and a slightly high signal intensity on a T2-weighted image. These tumors showed an enhancement of the peripheral zone in the early phase and low intake of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid- (Gd-EOB-DTPA-) enhanced MRI in the hepatobiliary phase (Figures 1(b) and 1(c)).
case_images: Esophagogastroduodenoscopy revealed an infiltrative ulcerative carcinoma (arrow) in the anterior wall of the antrum of the patient's stomach.
case_images: CRIE2017-7012520.002.jpg
case_images: PMC5442343_01_CRIE2017-7012520.002.jpg
case_images: fig2
case_images: Esophagogastroduodenoscopy revealed an infiltrative ulcerative carcinoma in the anterior wall of the antrum of the patient's stomach (Figure 2).
case_images: Histological examination of an ICC (a, d), gastric cancer (GC; (b, e)), and normal hepatocyte (c, f). Hematoxylin and eosin staining (x400) of an ICC (a), an adenocarcinoma suggesting GC (b), and normal hepatocyte (c). Immunohistochemical staining by anti-PTHrP antibody (H-137; Santa Cruz Biotechnology) in an ICC (d), GC (e), and normal hepatocyte (f).
case_images: CRIE2017-7012520.003.jpg
case_images: PMC5442343_01_CRIE2017-7012520.003.jpg
case_images: fig3
case_images: ICC (Figure 3(a)). Immunohistochemically, ICC tumor cells were positive for cytokeratin 7 and PTHrP (Figure 3(d)) and negative for cytokeratin 20, CDX2, and CA19-9. A histological examination of a biopsy specimen from the GC revealed an adenocarcinoma (Figure 3(b)). Immunohistochemically, GC tumor cells were positive for cytokeratin 7, cytokeratin 20, CDX2, and CA19-9 and were negative for PTHrP (Figure 3(e)).
case_images: The corrected serum Ca level was stable without bisphosphonate after the patient commenced chemotherapy with cisplatin (CDDP) and gemcitabine (GEM).
case_images: CRIE2017-7012520.004.jpg
case_images: PMC5442343_01_CRIE2017-7012520.004.jpg
case_images: fig4
case_images: Subsequently, his corrected calcium level was kept under 11 mg/dL without using elcatonin and bisphosphonate (Figure 4).
case_images: CT scans showed that the patient's liver tumors (arrows) were reduced by the 78th (a) and 238th day (b) of admission after chemotherapy with CDDP and GEM.
case_images: CRIE2017-7012520.005.jpg
case_images: PMC5442343_01_CRIE2017-7012520.005.jpg
case_images: fig5
case_images: On the 78th day, his liver tumors were reduced (Figure 5(a)). Moreover, on the 238th day, his liver tumors were smaller than tumors observed on the 78th day (Figure 5(b)).
case_images: Esophagogastroduodenoscopy showed that the patient's gastric cancer (arrow) was reduced on the 273rd day.
case_images: CRIE2017-7012520.006.jpg
case_images: PMC5442343_01_CRIE2017-7012520.006.jpg
case_images: fig6
case_images: In addition, the volume of his gastric cancer was also decreased on the 273rd day (Figure 6), suggesting that chemotherapy with CDDP and GEM was also effective for his gastric cancer.