SEVERE ATROPHY OF THE LEFT HEPATIC LOBE CAUSED BY CHOLANGIOCARCINOMA

Abstract

A 68-yaer-old female case of intrahepatic cholangiocarcinoma with severe atrophy of the left hepatic lobe is reported. Computed tomography showed a low density mass in the medial segment of the left lobe and atrophy of the lateral segment. Laparoscopic observations demonstrated the atrophic, white and thin lateral segment, indicating loss of hepatic parenchymal cell mass. Cystic dilatation with waxy-white appearance was seen on the surface of the atrophic left lobe. Yellowish-white metastatic nodules were observed on the parietal peritoneum and forceps biopsy was done for histological examination. Histology of biopsy specimen from a metastatic nodule showed metastatic adenocarcinoma with dense fibrous stroma and bile duct-like acinous formation, suggesting peritoneal metas-tasis of cholangiocarcinoma. We concluded that the severe atrophy of the lateral segment resulted from an occlusion of the left hepatic bile duct branch by tumor cell invasion. Laparoscopy was useful for diagnosis of cholangiocarcinoma with the severe atrophy of the left lobe and showed a characteristic feature of the surface of the liver with cholangiocar-cinoma before clinical manifestation of jaudice.