Ito Koji, Taira Kaoru, Arii Shigeki
Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Surg Today. 2009;39(3):256-60. doi: 10.1007/s00595-008-3831-6. Epub 2009 Mar 12.
We report a case of intrahepatic bile duct dilatation with a liver cyst and hemangioma. A 58-year-old woman was referred for investigation of a cystic lesion and peripheral intrahepatic bile duct dilatation in the left lateral segment of the liver. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) showed dilatation of the intrahepatic bile ducts in the left lateral segment, near a 4.5-cm cystic lesion. Early enhancement into the delayed phase was seen in the dorsal part of the cystic lesion. Celiac angiogram showed a belt-shaped hypervascular area, but no encasement or irregularity of the artery. To exclude malignancy, we performed a left lobectomy. Microscopically, the cyst was lined with a single layer of flattened epithelial cells and a spongy tumor was diagnosed as cavernous hemangioma, which compressed the bile duct. The histopathological diagnosis was biliary stenosis associated with cavernous hemangioma of the liver. Invasive surgery may be avoided by awareness of this unusual benign pathology.
我们报告一例伴有肝囊肿和血管瘤的肝内胆管扩张病例。一名58岁女性因肝左外叶囊性病变及周边肝内胆管扩张而前来接受检查。腹部计算机断层扫描(CT)和磁共振成像(MRI)显示肝左外叶肝内胆管扩张,靠近一个4.5厘米的囊性病变。囊性病变背侧可见早期强化并持续至延迟期。腹腔动脉造影显示有一条带状高血管区,但动脉未被包绕或出现不规则情况。为排除恶性病变,我们实施了左叶切除术。显微镜下,囊肿内衬单层扁平上皮细胞,一个海绵状肿瘤被诊断为海绵状血管瘤,其压迫了胆管。组织病理学诊断为与肝海绵状血管瘤相关的胆管狭窄。认识到这种不寻常的良性病理情况可避免进行侵入性手术。