Masuda Tomoya, Kobashi Kenta, Sugimoto Ryoma, Ishii Hiroshi, Tsunemitsu Kensuke
Department of Surgery, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo-Shi, Ehime, 793-0027, Japan.
Surg Case Rep. 2023 Mar 23;9(1):43. doi: 10.1186/s40792-023-01625-8.
Liver tumors with liver abscesses are unusual and rarely reported. In particular, studies of intrahepatic cholangiocarcinoma with liver abscesses due to hepatic actinomycosis have not been reported.
A 73-year-old woman presented with swelling of the right hypochondrium. Computed tomography revealed a mass lesion that was continuous with the abdominal wall in the right lobe of the liver, suggesting a liver tumor invading the abdominal wall. A liver biopsy revealed intrahepatic cholangiocarcinoma with a liver abscess. The histopathological specimen contained bacterial masses of actinomycosis, and the cause of the liver abscess was determined to be hepatic actinomycosis. As a result of percutaneous drainage and antibiotic therapy, the part of the tumor attached to the abdominal wall disappeared; therefore, we assumed that most of the lesion was not cholangiocarcinoma but a liver abscess due to hepatic actinomycosis. Radical surgery for residual intrahepatic cholangiocarcinoma was performed after chemotherapy. Currently, the patient is alive without recurrence 2 years and 9 months after the operation.
We encountered a difficult-to-diagnose case of intrahepatic cholangiocarcinoma with a liver abscess due to hepatic actinomycosis. A needle biopsy allowed early diagnosis and percutaneous drainage was an effective treatment.
伴有肝脓肿的肝肿瘤较为罕见，相关报道不多。尤其是，关于肝放线菌病所致肝脓肿合并肝内胆管癌的研究尚未见报道。
一名73岁女性因右季肋部肿胀就诊。计算机断层扫描显示肝脏右叶有一个与腹壁相连的肿块，提示肝肿瘤侵犯腹壁。肝脏活检显示为肝内胆管癌合并肝脓肿。组织病理学标本中含有放线菌病的细菌团块，肝脓肿的病因确定为肝放线菌病。经皮引流和抗生素治疗后，附着于腹壁的肿瘤部分消失；因此，我们推测大部分病变并非胆管癌，而是肝放线菌病所致的肝脓肿。化疗后对残留的肝内胆管癌进行了根治性手术。目前，患者术后2年9个月仍存活，无复发。
我们遇到了一例因肝放线菌病导致的肝脓肿合并肝内胆管癌的疑难诊断病例。穿刺活检有助于早期诊断，经皮引流是一种有效的治疗方法。
