A Large Intrahepatic Cholangiocarcinoma of Intraductal Growth Type with Invasion to the Stroma and the Gallbladder in Hepatitis B Virus Carrier -A Case Report

Seiji Maruyama¹⁾, Takashi Nishizaki¹⁾, Hideki Ijichi¹⁾, Takahiro Terashi¹⁾, Rinsyun Shimabukuro¹⁾, Shunji Takechi²⁾, Kouji Joko²⁾, Shinji Yoshioka³⁾, Shigetoshi Murata³⁾ and Yumi Ohshiro⁴⁾

Department of Surgery¹⁾, Center for Liver and Biliary Diseases²⁾, Department of Radiology³⁾ and Department of Pathology⁴⁾, Matsuyama Red Cross Hospital

A 47-year-old woman, a hepatitis B virus (HBV) carrier, with a large right hepatic lobe tumor detected by ultrasonography during routine HBV follow-up was found in enhanced computed tomography (CT) and superparamagnetic iron oxide-enhanced magnetic resonance imaging (SPIO-MRI) to have a tumor 10.0×9.0 cm in diameter in the right hepatic lobe and segment 4. CEA was 706.7 ng/ml and CA19-9 was >12,000 U/ml. Preoperative differential diagnoses included intrahepatic cholangiocarcinoma (ICC), combined hepatocellular and cholangiocarcinoma, and bile duct cystadenocarcinoma of the liver. Preoperative radiological examination showed no apparent distant metastasis. Preoperative liver function tests showed Child-Pugh Grade A, so we conducted right hepatic trisegmentectomy. Pathological findings showed well-differentiated adenocarcinoma with papillary growth mainly in the bile duct, and the tumor was diagnosed intraductal growth cholangiocarcinoma involving lymph node metastases (No.12b, 12p, 12c) and tumor invasion to the gallbladder. The postoperative course was uneventful and the woman remains well and recurrence-free 7 months after surgery.

Key words
intrahepatic cholangiocarcinoma, intraductal growth, HBV

Reprint requests
Seiji Maruyama Department of Surgery, Matsuyama Red Cross Hospital
1 Bunkyo-cho, Matsuyama, 790-8524 JAPAN

Accepted
September 16, 2009

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