肝実質内に腫よう巣を指摘しえなかった胆管内発育型肝細胞癌の２切除例

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  • Two Cases of Hepatocellular Carcinoma with Bile Duct Invasion, but without a Detectable Tumor in the Liver

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Hepatocellular carcinoma (HCC) with tumor invasion into the bile duct but without a detectable tumor in the liver is rare, being observed in only 2 (0.4%) of 484 patients undergoing hepatectomy for HCC in our department. The first patient, who had a tumor thrombus in the anterior branch of the bile duct, underwent anterior segmentectomy and removal of the bile duct tumor. The second patient, who had a tumor thrombus in the left bile duct and a solitary nodule at subsegment 8 (S8), underwent left lobectomy, removal of the bile duct tumor, and percutaneous ethanol injection therapy (PEIT) for the tumor at S8. Histopathological examination of resected specimens could not identify the tumor in the liver, but poorly differentiated HCC was diagnosed in both cases. A biopsy sample of the S8 tumor showed well-differentiated HCC. The first patient died of intrahepatic recurrence 5 months after surgery. The second patient also developed intrahepatic recurrence and died 3 years after surgery. The prognosis of these patients was poor because the tumor was poorly differentiated. In addition to surgery, development of the effective neoadjuvant therapy is mandatory for this type of HCC.

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