Kimura H, Kagawa K, Deguchi T, Sumida Y, You K, Komaki T, Teramae N, Fukui S, Kawakami S, Fujita Y
Department of Internal Medicine, Fukuchiyama City Hospital, Japan.
J Gastroenterol. 1998 Dec;33(6):895-8. doi: 10.1007/s005350050196.
A 54-year-old man, who had no clinical symptoms, underwent a routine health checkup at our hospital. Abdominal ultrasonography disclosed a well demarcated tumor containing a solid portion occupying the dilated left hepatic duct and a cystic portion expanding into the parenchyma of the left hepatic lobe, with mild dilatation of the intrahepatic bile ducts. These findings were later confirmed by computed tomography (CT) and magnetic resonance imaging. Endoscopic retrograde cholangiography revealed a complete defect at the level of the left hepatic duct, while drip infusion cholangiographic-CT (DIC-CT) disclosed a defect of the left hepatic duct only, with the distal portions of the left intrahepatic ducts being visualized on the image. Hepatic angiography revealed light stains in the solid portion in the parenchymal phase. At left lobectomy, a multiloculated polyp-like tumor was found arising from the left hepatic duct and expanding into the parenchyma of the left hepatic lobe. Microscopically, all the lining cells in the cysts and the tumor cells in the solid portion showed the features of papillary adenocarcinoma. In this patient with extrahepatic biliary cystadenocarcinoma, DIC-CT was useful in identifying the site of origin of the tumor, and hepatic angiography was also useful in differentiating this rare malignant tumor from benign cystadenoma.
一名54岁无症状男性在我院接受常规健康检查。腹部超声检查发现一个边界清晰的肿瘤，其包含一个占据扩张的左肝管的实性部分以及一个延伸至左肝叶实质内的囊性部分，同时肝内胆管有轻度扩张。这些发现随后经计算机断层扫描（CT）和磁共振成像得到证实。内镜逆行胆管造影显示左肝管水平存在完全缺损，而滴注式胆管造影CT（DIC-CT）仅显示左肝管缺损，左肝内胆管远端部分在图像上可见。肝血管造影显示实质期实性部分有淡染色。左叶切除术中，发现一个多房性息肉样肿瘤起源于左肝管并延伸至左肝叶实质内。显微镜下，囊肿内所有衬里细胞及实性部分的肿瘤细胞均显示为乳头状腺癌特征。在这名肝外胆管囊腺癌患者中，DIC-CT有助于确定肿瘤的起源部位，肝血管造影也有助于将这种罕见的恶性肿瘤与良性囊腺瘤相鉴别。
