A rare case of intrahepatic cholangiocarcinoma with tumor thrombus in the bile duct
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CASE REPORT
A rare case of intrahepatic cholangiocarcinoma with tumor thrombus in the bile duct Atsushi Nanashima1 · Kunihiko Tominaga2 · Akihiro Yonei3 · Ryo Sekiya3 · Syoutaro Oshikawa4 · Yuichiro Sato5 · Norio Wake3 · Jun Akiba6 Received: 29 July 2020 / Accepted: 15 October 2020 © Japanese Society of Gastroenterology 2020
Abstract Intrahepatic cholangiocarcinoma (ICC) is a refractory liver malignancy; however, as its histological characteristics have been clarified, a good operative strategy for the subtypes of ICC can be expected. A 72-year-old woman was diagnosed with a large primary liver cancer with biliary tumor thrombus (BTT) and obstructive jaundice. An enhanced imaging modality showed hypervascular ICC or combined hepatocellular carcinoma (HCC). As her liver functional parameters permitted major hepatectomy, preoperative biliary drainage was performed, followed by a radical left hepatectomy accompanied by tumor thrombectomy with D2 lymphadenectomy. During the operation, the BTT was found to have widely spread into the right hepatic duct and the common bile duct and was histologically diagnosed as an adenocarcinoma. As ductal cancer invasion was not macroscopically observed, the planned operation was completed. The postoperative histological diagnosis was determined by discussion to be a rare mass-forming ICC with BTT. Her postoperative course was uneventful, and a 1-year survival without tumor relapse was observed with adjuvant chemotherapy. In the field of biliary surgery, although advanced ICC still has a poor prognosis, curable surgical intervention is possible for specific findings, such as BTT and HCC with BTT. Keywords Intrahepatic cholangiocarcinoma · Bile duct · Tumor thrombus · Hepatectomy · Histology
Introduction Intrahepatic cholangiocarcinoma (ICC) can be surgically resected, and its histological origin with specific characteristics has been noted [1, 2]. Although the various types of ICC and their histological characteristics were defined by the * Atsushi Nanashima [email protected]‑u.ac.jp 1
Division of Hepato‑Biliary‑Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889‑1692, Japan
2
Department of Pathology, Miyazaki Zenjinkai Hospital, Miyazaki, Japan
3
Department of Surgery, Miyazaki Zenjinkai Hospital, Miyazaki, Japan
4
Department of Medicine, Miyazaki Zenjinkai Hospital, Miyazaki, Japan
5
Department of Diagnostic Pathology, University of Miyazaki Hospital, Miyazaki, Japan
6
Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka, Japan
World Health Organization (WHO), histological diagnosis of these types and the differential diagnosis of combined hepatocellular carcinoma (HCC) and ICC seem to be inconsistent among physicians and pathologists [3–5]. In the latest WHO classification published in 2019, ICC and combined HCC with ICC were both simply and clearly defined by histological consensus [6]. However, the clinical characteristics and histological diagnosis of t
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