Conversion surgery after gemcitabine and cisplatin plus durvalumab for advanced intrahepatic cholangiocarcinoma: A case report

Figure 1 Dynamic computed tomography before and after eight courses of gemcitabine and cisplatin plus durvalumab. A: Advanced intrahepatic cholangiocarcinoma at the left hepatic duct; B: Tumor invasion of the umbilical portion of the portal vein; C: Suspected direct invasion of the extrahepatic bile duct. Bile duct wall enhancement continuous from the tumor extended to the anterior and posterior sectoral duct; D: Tumor showing remarkable shrinkage; E: Amelioration of the dilation of the intrahepatic bile duct; F: Bile duct wall enhancement showing significant decrease at the anterior and posterior sectoral duct. Yellow arrows indicate the following findings.

Figure 2 Changes in carcinoembryonic antigen and carbohydrate antigen 19-9 tumor marker levels and timeline of the gemcitabine and cisplatin plus durvalumab regimen. Numbers 1–8 indicate the treatment cycle. “D” indicates durvalumab maintenance therapy. CA 19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen.

Figure 3 Resection margins. A: Macroscopic findings of mass-forming and periductal-infiltrating intrahepatic cholangiocarcinoma; B: Hematoxylin and eosin (HE) staining of the preoperative biopsy specimen confirming the adenocarcinoma diagnosis; C and D: HE staining of the resected tumor. Small ductular-like structures lined by small nonmucinous cuboidal cells, characteristic findings in small duct type intrahepatic cholangiocarcinomas.