Cover Illustration: A Case of Cholangiocellular Carcinoma, Mass-forming Plus Periductal Infiltrating Type
A 74-year-old male visited our institute with a complaint of body weight loss. Abdominal CT scan revealed a low-density mass with irregular surface, sized 2cm in diameter, and located in segment IV–III of the liver. A mild dilation of the biliary trees was found in segment III of the liver. On dynamic CT scan (Cover Illustration A), the central part of the tumor was not enhanced (black arrow) and the peripheral area was slightly enhanced on the delayed-phase. An irregular low-density area surrounded the umbilical portion of the left portal vein, which suggested the periductal infiltration of the cancer cells (white arrow). On magnetic resonance imaging (MRI), the tumor showed low-intensity signal on T1-weighted image and high-intensity signal on T2-weighted image, and also on super-paramagnetic iron oxide-enhanced MRI (SPIO-MRI) (Figure B). On angiograms, the left portal vein was not visualized. Results of all the laboratory examinations including tumor markers were within normal ranges. A preoperative diagnosis of cholangiocellular carcinoma in the left liver (mass-forming plus periductal infiltrating type) was made.
A left hemihepatectomy combined with removal of the entire caudate lobe and extrahepatic bile duct was performed successfully. The postoperative course was uneventful.
Histopathological diagnosis was cholangiocellular carcinoma, moderately differentiated adenocarcinoma (Figure C). In accordance with the preoperative diagnosis, the tumor was mass-forming plus periductal infiltrating type. The tumor cells mainly proliferated into the liver parenchyma and were also spreading along the left portal area, for 7cm in the length longitudinally. The left portal vein and the left hepatic artery were involved by the tumor. The surgical margin was negative and no lymph node metastasis was found.
(Ayu Hosokawa and Hidenori Ojima, National Cancer Center, Japan)
[Table of Contents]