Nakamura Tsukasa, Harada Shumpei, Nakao Toshimasa, Masuda Koji, Wilkinson Gareth, Sako Hirotaka, Yoshimura Norio
Department of Transplant and General Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto- prefecture, Japan
Department of Transplant and General Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto- prefecture, Japan.
J Surg Case Rep. 2013 Aug 29;2013(8):rjt055. doi: 10.1093/jscr/rjt055.
Peripheral intrabiliary liver metastases (PILM) from colorectal carcinoma are rare, and this feature, which resembles primary cholangiocarcinoma, potentially misleads the accurate diagnosis and subsequent surgical treatment. A 67-year-old man with a medical history of descending colon carcinoma demonstrated an abnormal rise in CA19-9. There was a strong possibility of peripheral cholangiocarcinoma, because Computed tomography detected tumour infiltration into bile duct three. The patient underwent anatomic segment eight and lateral lobe resection. Pathological findings revealed that every tumour was metastatic liver carcinoma due to descending colon carcinoma. Cases of liver metastasis which resemble peripheral cholangiocarcinoma might be difficult to distinguish preoperatively. The correct diagnosis is important in making decisions regarding the surgical management of such patients. Nonanatomic hepatectomy is often performed for liver metastases from colorectal carcinomas. Anatomic hepatectomy, however, should be recommended in cases of PILM.
结直肠癌的外周肝内胆管转移(PILM)较为罕见,这种类似原发性胆管癌的特征可能会误导准确诊断及后续手术治疗。一名有降结肠癌病史的67岁男性,其CA19-9出现异常升高。由于计算机断层扫描检测到肿瘤浸润至三级胆管,故高度怀疑为外周胆管癌。该患者接受了肝段八切除及肝左外叶切除术。病理结果显示,每个肿瘤均为降结肠癌肝转移。术前可能难以区分类似外周胆管癌的肝转移病例。正确诊断对于此类患者手术治疗决策至关重要。结直肠癌肝转移通常采用非解剖性肝切除术。然而,对于外周肝内胆管转移病例,应推荐解剖性肝切除术。