Mass-forming intrahepatic cholangiocarcinoma with portal vein tumor thrombus and bile duct tumor thrombus: A case report

Iwaki, Kentaro; Kaido, Toshimi; Yamamoto, Gen; Kamo, Naoko; Yagi, Shintaro; Taura, Kojiro; Üemoto, Shinji

doi:10.1016/j.ijscr.2017.08.059

Cited by 2 publications

(1 citation statement)

References 12 publications

(22 reference statements)

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“…The presence of bile duct tumor thrombus associated to ICC is a very rare finding, being more common in case of hepatocellular carcinoma (2-9%) (27,28). Indeed, we found only 7 such former case reports after reviewing the literature (29,30,31). In the most recent one, the authors choose to perform thrombectomy in order to avoid surgical complications, even though they admitted that extrahepatic bile duct resection and reconstruction are recommended for ICC.…”

Section: Discussion Discussionmentioning

confidence: 96%

Intrahepatic Cholangiocarcinoma Involving the Hepatocaval Confluence with Bile Duct Tumor Thrombus Mimicking a Klatskin Tumor: A Case Report

Botea¹,

Barcu²,

Picu³

et al. 2018

SGO

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Background: Intrahepatic cholangiocarcinoma (ICC) is a rare malignant tumor arising from the epithelial cells of the intrahepatic bile ducts. The aim of the present paper is to report a rare case of centrally located ICC involving the hepatocaval confluence and generating a tumor thrombus in the biliary duct of segment 4 expanding into the left hepatic duct and main common duct, mimicking a type IIIB Klatskin tumor. Case presentation: A 66-year old female presented for epigastric abdominal pain and weight loss, with cytolysis (ALAT= 323 U/l; normal ASAT), high GGT (618 U/L), but normal phosphatase alkaline and bilirubin levels; CA 19-9 was elevated (257 U/mL), while CEA was normal. At dual-phase multi-detector CT and magnetic resonance cholangiopancreatography, a simultaneous ICC and type IIIB perihilar cholangiocarcinoma (Klatskin tumor) were diagnosed. Intraoperatively, the ICC located in segments 1, 4 and 8, infiltrating the left and middle hepatic veins and in contact with the right hepatic vein was confirmed, while the hilar lesion proved to be a bile duct tumor thrombus originating from the ICC. Consequently, a left hepatectomy extended to segments 1 and 8 with hilar approach, with en-bloc resection of main biliary duct, and hilar lymph node dissection was performed. The right hepatic vein and an accessory middle hepatic vein were preserved, accepting 0-mm resection margin at this level. The postoperative outcome was remarkably uneventful. Conclusion: Locally advanced ICC is a challenging presentation for both diagnosis and treatment, for which complex major liver resection is effective when performed in a high volume HPB center.

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Section: Discussion Discussionmentioning

confidence: 96%

Intrahepatic Cholangiocarcinoma Involving the Hepatocaval Confluence with Bile Duct Tumor Thrombus Mimicking a Klatskin Tumor: A Case Report

Botea¹,

Barcu²,

Picu³

et al. 2018

SGO

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Small intestinal obstruction due to the metastasis of intrahepatic cholangiocarcinoma

Akiyama¹,

Nagahori²,

Oooka³

et al. 2018

Medicine

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Rationale:The small intestine (SI) does not commonly harbor cancer but is occasionally involved by metastatic cancer from other organs. To manage SI cancer appropriately, surveillance for primary origin outside the SI is essential.Patient concerns:This study presents a 54-year-old Thai man diagnosed with SI obstruction which required laparoscopy- assisted partial ileal resection.Diagnoses:On the basis of the expression pattern of cytokeratins (CKs) and mucins (MUCs) in the resected SI adenocarcinoma, we suspected this was metastasized from the pancreatobiliary tract. Imaging studies revealed a hepatic segmental atrophy with an occlusion of the posterior segmental blanch of the portal vein without any contrast-enhanced lesions in the liver. Pathology of the liver biopsy revealed intrahepatic cholangiocarcinoma (ICC) with the same expression pattern of CKs and MUCs as the SI adenocarcinoma.Interventions:Systemic chemotherapy (gemcitabine and cisplatin) was initiated.Outcomes:Despite of the chemotherapy for 20 months, he died of ICC.Lessons:This is the first case of SI obstruction caused by the metastasis of ICC. We demonstrate that immunohistochemical staining of CKs and MUCs discriminate between primary and metastatic SI cancer and predict its primary origin outside the SI. This case also suggests that a hepatic segmental atrophy with portal vein occlusion would be an atypical but important finding to diagnose ICC.

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Mass-forming intrahepatic cholangiocarcinoma with portal vein tumor thrombus and bile duct tumor thrombus: A case report

Cited by 2 publications

References 12 publications

Intrahepatic Cholangiocarcinoma Involving the Hepatocaval Confluence with Bile Duct Tumor Thrombus Mimicking a Klatskin Tumor: A Case Report

Intrahepatic Cholangiocarcinoma Involving the Hepatocaval Confluence with Bile Duct Tumor Thrombus Mimicking a Klatskin Tumor: A Case Report

Small intestinal obstruction due to the metastasis of intrahepatic cholangiocarcinoma

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