CPC viewed from pathologists: a case of cholangiocarcinoma with arterial and venous thromboembolism

Hiroyuki Sugihara 1, Sizuki Tukashita 1, Megumi Yamahira 2, Masahiro Yamamoto 3, Toshiyuki Tsujioka 3

1 Department of Pathology, Shiga University of Medical Science
2 Department of Internal Medicine, Kohka Public Hospital
3 Department of Central Clinical Laboratory, Kohka Public Hospital

 We report a CPC record on an autopsy case of 58-year-old female who suffered from rapidly growing cholangiocarcinoma. Two months before death, an abdominal CT disclosed an inoperable tumor, 8 cm in diameter, in the liver, whereas another CT taken 21 months before death failed to detect any tumor in the corresponding area. She received terminal care for the control of pain and infection and died of DIC. At autopsy, we inferred that the cause of DIC was not acute cholangitis but extensive necrosis in cholangiocarcinoma of liver, which may be also a reason for the rapid growth of the tumor (doubling time: 2 months). Blood-born metastases of the tumors were detected systemically in the absence of lung metastasis. DIC was accompanied by non-bacterial thrombotic endocarditis and subsequent arterial thromboembolism in heart, spleen and kidneys. The main cause of death was respiratory failure by DIC-based diffuse alveolar damage and pulmonary thromboembolism with occlusion of the left lower trunk. We discussed on the growth kinetics of the tumor, the rout of metastasis and the sequence of thromboembolic events in this case.

Key words: CPC, cholangiocarcinoma, thromboembolism