Shimamura Kazuhiko, Kurosaki Isao, Sato Daisuke, Takano Kabuto, Yokoyama Naoyuki, Sato Yoshinobu, Hatakeyama Katsuyoshi, Nakadaira Keiko, Yagi Minoru
Division of Digestive and General Surgery, Department of Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan.
Surg Today. 2009;39(3):247-51. doi: 10.1007/s00595-008-3825-4. Epub 2009 Mar 12.
We report a rare case of intrahepatic cholangiocarcinoma (IHCC) arising many years after excision of a type IV-A congenital choledochal cyst. A 44-year-old man was transferred to our hospital with acute cholangitis more than 34 years after several operations for congenital biliary dilatation. Imaging showed a huge tumor in the left medial section of the liver, extending to the porta hepatis. Although he had no jaundice, the intrahepatic bile ducts showed cylinder-like dilatation with narrowing of the hilar bile duct. At surgery, the tumor was found to arise from the dilated intrahepatic bile duct just above the narrow portion. He underwent a left hepatic trisectionectomy with a vascular procedure. Microscopically, the tumor was confirmed to be moderate-to-well-differentiated tubular adenocarcinoma. Thus, when the narrow segment is left untouched, careful long-term follow-up is important to detect new lesions at an early stage.
我们报告了一例罕见的肝内胆管癌（IHCC）病例，该病例发生在IV-A型先天性胆总管囊肿切除多年之后。一名44岁男性在接受先天性胆管扩张多次手术后34年以上，因急性胆管炎转入我院。影像学检查显示肝脏左内侧段有一个巨大肿瘤，延伸至肝门。尽管他没有黄疸，但肝内胆管呈圆柱状扩张，肝门部胆管狭窄。手术中发现肿瘤起源于狭窄部位上方扩张的肝内胆管。他接受了左半肝切除术及血管手术。显微镜检查证实肿瘤为中分化至高分化管状腺癌。因此，当狭窄段未处理时，仔细的长期随访对于早期发现新病变很重要。
