2015 Volume 29 Issue 2 Pages 285-291
The patient was a 62-year-old female who visited a physician for a chief compliant of jaundice. Increased hepatobiliary enzyme levels and a liver tumor were pointed out, and she was referred to our hospital. On abdominal ultrasonography, an about 70-mm tumorous lesion accompanied by peripheral bile duct dilation was noted in the liver S4/5, and the tumor was ischemic and heterogeneous on abdominal CT. In addition, hypertrophy of the wall was observed in the distal bile duct. On ERC, stenosis of the bilateral hepatic duct-joining region and irregular stenosis and dilation of the right intrahepatic bile duct were observed. Moreover, a filling defect was detected in the distal bile duct, and this region was diagnosed as adenocarcinoma on biopsy. Based on the above findings, the patient was diagnosed with double cancer of intrahepatic and distal cholangiocarcinoma, and right trisegmentectomy+subtotal stomach-preserving pancreatoduodenectomy was performed. On histopathological examination, intrahepatic cholangiocarcinoma was moderately differentiated tubular adenocarcinoma, and distal cholangiocarcinoma was papillary adenocarcinoma. This is the second case of synchronous development of intra- and extrahepatic cholangiocarcinoma in Japan, and so is very rare.
