Surgery, Gastroenterology and Oncology
Vol. 23, Nr. 6, Dec 2018
Intrahepatic Cholangiocarcinoma Involving the Hepatocaval Confluence with Bile Duct Tumor Thrombus Mimicking a Klatskin Tumor: A Case Report
Florin Botea, Alexandru Barcu, Nausica Picu, Ruxandra Fota, Irinel Popescu
Images in Clinical Medicine, Dec 2018
Article DOI: 10.21614/sgo-23-6-399
Background: Intrahepatic cholangiocarcinoma (ICC) is a rare malignant tumor arising from the epithelial cells of the intrahepatic bile ducts.
The aim of the present paper is to report a rare case of centrally located ICC involving the hepatocaval confluence and generating a tumor thrombus in the biliary duct of segment 4 expanding into the left hepatic duct and main common duct, mimicking a type IIIB Klatskin tumor.

Case presentation: A 66-year old female presented for epigastric abdominal pain and weight loss, with cytolysis (ALAT= 323 U l; normal ASAT), high GGT (618 U L), but normal phosphatase alkaline and bilirubin levels; CA 19-9 was elevated (257 U mL), while CEA was normal. At dual-phase multi-detector CT and magnetic resonance cholangiopancreatography, a simultaneous ICC and type IIIB perihilar cholangiocarcinoma (Klatskin tumor) were diagnosed. Intraoperatively, the ICC located in segments 1, 4 and 8, infiltrating the left and middle hepatic veins and in contact with the right hepatic vein was confirmed, while the hilar lesion proved to be a bile duct tumor thrombus originating from the ICC.
Consequently, a left hepatectomy extended to segments 1 and 8 with hilar approach, with en-bloc resection of main biliary duct, and hilar lymph node dissection was performed. The right hepatic vein and an accessory middle hepatic vein were preserved, accepting 0-mm resection margin at this level. The postoperative outcome was remarkably uneventful.

Conclusion: Locally advanced ICC is a challenging presentation for both diagnosis and treatment, for which complex major liver resection is effective when performed in a high volume HPB center.

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Surgery, Gastroenterology and Oncology is indexed in Scopus, CrossRef (DOI: 10.21614/sgo)

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