Lucidi V, Van Laethem J L, Sersté T, Gelin M, Donckier V
Medicosurgical Department of Hepatogastroenterology, Hôpital Erasme, Universite Libre de Bruxelles, 808 route de Lennik, 1070 Brussels, Belgium.
J Gastrointest Surg. 2008 Jun;12(6):1149-50. doi: 10.1007/s11605-007-0307-8. Epub 2007 Sep 6.
Peripheral cholangiocarcinoma with endobiliary thrombus could be confused with Klatskin tumor, eventually leading to inappropriate therapeutic decision.
A 56-year-old man presented with an obstructive jaundice. Preoperative magnetic resonance imaging (MRI) showed a segment 7 liver tumor associated with a complete stop at the biliary bifurcation compatible with a Klatskin tumor. Surgical exploration revealed that biliary obstruction was caused by endobiliary tumor-related thrombus. A right hepatectomy was performed, allowing complete endobiliary thrombus extraction. At pathology, a T2N0 intrahepatic cholangiocarcinoma was demonstrated. No adjuvant chemotherapy was given and currently, 22 months after surgery, the patient remains disease free.
This case underlines the fact that intraductal growth of peripheral cholangiocarcinoma does not represent a contraindication for surgical treatment. MRI could be useful to differentiate such presentation of peripheral cholangiocracinoma from Klatskin tumor and orientate the surgical treatment.
伴有胆管内血栓的周围型胆管癌可能会与肝门部胆管癌相混淆，最终导致不恰当的治疗决策。
一名56岁男性出现梗阻性黄疸。术前磁共振成像（MRI）显示肝段7肿瘤，在胆管分叉处完全阻塞，符合肝门部胆管癌表现。手术探查发现胆管梗阻是由胆管内肿瘤相关血栓引起。行右半肝切除术，完整取出胆管内血栓。病理显示为T2N0期肝内胆管癌。未给予辅助化疗，目前术后22个月，患者无疾病复发。
该病例强调了周围型胆管癌的导管内生长并不构成手术治疗禁忌这一事实。MRI有助于将周围型胆管癌的这种表现与肝门部胆管癌相鉴别，并指导手术治疗。
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