A case of mucin producing liver metastases with intrabiliary extension

Abstract

A 75-year-old man was admitted to our hospital with a diagnosis of liver metastases from colon cancer. He underwent right hemicolectomy for cecal cancer eight years ago, and had a metastatic liver tumor in segment 8 (S8), which was surgically resected about 4 years after the initial operation. Histopathological examination of the resected specimens from both operations revealed a welldifferentiated adenocarcinoma with mucinous carcinoma. Four months after the second operation, computed tomography demonstrated a low-density lesion at the cut surface of the remnant liver. Although it was considered to be a postoperative collection of inflammatory fluid, it formed a cystic configuration and increased in size to approximately 5 cm in diameter. With a tentative diagnosis of a recurrence of metastatic cancer, partial hepatectomy of S8 was performed. Histological examination of the resected specimens also revealed mucinous adenocarcinoma, which had invaded into the biliary ducts, replacing and extending along its epithelium. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 20, but negative for CK7. Therefore, the tumor was diagnosed as a metastatic adenocarcinoma from colonic cancer. Liver metastases of colorectal adenocarcinoma sometimes invade the Glisson's triad and grow along the biliary ducts.

Intraductal papillary growth of liver metastasis originating from colon carcinoma in the bile duct: Report of a case

“…3,5,6,8,15 Tumor growth confined to the bile duct, as in the present case, has rarely been described. 3,5,16 Itatsu et al 3 and Blumgart et al 16 Nanashima et al, Page 7 provided summaries of a small number of cases.…”

“…[3][4][5][6][7] The morphology of this tumor resembled a rare biliary carcinoma termed "intraductal papillary neoplasm of the bile duct" (IPNB) by Nakanuma and Chen et al 8,11,12 As in IPNB, the tumor in the present report showed marked dilatation of the bile duct without jaundice was observed with or without mucin secretion. 11,12 The histological findings of intraductal papillary growth of liver metastasis were also similar to IPNB as a papillary proliferation of carcinoma in the epithelium.…”

“…11,12 The histological findings of intraductal papillary growth of liver metastasis were also similar to IPNB as a papillary proliferation of carcinoma in the epithelium. 3,5,6,8 Because histological differentiation was different in the metastatic lesion and the primary carcinoma, we believed that the present tumor represented primary carcinoma in the bile duct. We have previously treated cases of IPNB similar to the present case, and several of these cases showed in situ carcinomas with or without adenoma that superficially extended along the biliary epithelium.…”

“…This information would be useful for predicting this type of invasion of liver metastasis; 3-9, 16, 17 however, the precise prediction of biliary infiltration of liver metastasis from only the gross appearance would be difficult because of the possibility of special types of cholangiocarcinoma, as described above. 8,11,12 Most patients underwent surgery, because of the diagnostic development on imaging. 15 CT might be the most powerful imaging modality, although the usefulness of percutaneous transhepatic cholangiography was reported by Hiramatsu et al 17 Advanced imaging modalities can identify dilation and cystic changes in the biliary duct in the early stage.…”

“…[3][4][5][6][7] This type of tumor usually shows biliary invasion of the main mass lesion and sometimes resembles intrahepatic cholangiocarcinoma with intraductal growth. [5][6][7][8][9] Immunohistochemical examination is necessary to differentiate between metastatic liver carcinoma and cholangiocarcinoma. 7,9,10 We report a case of liver metastasis resembling intra-hepatic cholangiocarcinoma.…”