A case of gallbladder carcinoma producing both .ALPHA.-fetoprotein and carcinoembryonic antigen and responding effectively to methotrexate, 5-FU sequential therapy.

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A 70-year-old woman was admitted to our hospital with complaints of feeling fullness in the abdomen. A hard mass was palpable until 12cm below the left costal arch. The AFP and CEA serum levels were 15, 400ng/ml and 53.8ng/ml respectively at the time of admission.<BR>Ultrasonography and CT-scan revealed a mass filling the lumen of the gallbladder and many space-occupying lesions in the liVer. Hepatic arteriography revealed an irregular cystic artery and many tumor stains in the liver. Biopsied specimens of the liver tumor obtained under laparoscopy were found to be histologically adenocarcinoma papillotubulare and a diagnosis of gallbladder carcinoma was made. The AFP pattern analyzed by crossed immuno-affinoelectrophoresis with concanavalin A and Lens culinaris agglutinin was like that of yolk sac tumors rather than that of hepatocellular carcinoma.<BR>Methotrexate, 5-FU sequential therapy was effective in this case. At the second admission, this therapy was given for 5 times with a subsequent reduction in AFP obtained from 74, 000ng/ml to 8, 600ng/ml and in CEA from 3, 500ng/ml to 326ng/ml. Furthermore, decrease in the tumor size was recognizable through palpitation and CT scan. The patient died after about 1 year from hepatic failure. The autopsy showed a hard mass filling the lumen of the gallbladder and many metastatic lesions in the liver, lungs, and hepatic hilar lymphnodes. Histologically, the tumor was adenocarcinoma papillotubulare.<BR>Immunohistochemically, the carcinoma cells showed positive staining for AFP and CEA by peroxidase-conjugated antibody methods. The carcinoma was thus responsible for producing both of them.

A case of gallbladder carcinoma producing both .ALPHA.-fetoprotein and carcinoembryonic antigen and responding effectively to methotrexate, 5-FU sequential therapy.

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