PMC6111009_01
Preoperative findings.. a CT showed multilocular cystic dilatation and an enhanced mass in B3 (arrowhead).. b Drip infusion cholangiography CT showed a defect extending from the left hepatic duct to the common hepatic duct (arrowhead).. c ERC showed an interruption in the left hepatic duct above a confluence of main hepatic ducts and a defect with mucin below (arrowhead).. d Intraductal ultrasonography revealed a 15-mm intraductal growth type mass located between the left and common hepatic ducts.
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Contrast-enhanced computed tomography (CT) showed multilocular cystic dilatation and an enhanced mass in the hepatic duct of segment 3 (B3) (Fig. 1a). Drip infusion cholangiography CT showed a defect extending from the left hepatic duct (LHD) to the common hepatic duct (CHD) (Fig. 1b). Endoscopic retrograde cholangiography (ERC) showed an interruption in LHD above the confluence of the main hepatic ducts and a defect with mucin below (Fig. 1c). Intraductal ultrasonography revealed a 15-mm intraductal mass located between LHD and CHD (Fig. 1d).
Operative finding and appearance of resected specimens.. a Liver parenchyma of segment 3 was remarkably atrophic, and B3 filled with tumors were seen as irregular masses on the surface of segment 3.. b,c Macroscopic and microscopic findings of the resected specimen. B3 was filled with a biliary neoplasm comprising atypical epithelial cells arranged in a highly papillary architecture and over secreting mucin.
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B3 was filled with tumors that appeared as irregular masses on the surface of segment 3 (Fig. 2a). The neoplasm spread from B3 to LHD (Fig. 2b and c).
Images showing recurrent tumor.. a CT showed a lesion diffusely spread in the remnant intrahepatic bile duct.. b A drainage stent was placed within B5 filled with recurrent tumor (arrowhead).. c Internal drainage stents were replaced within B5 and B8 across the anastomosis.
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At 17 months postoperatively, the patient had jaundice, and CT revealed a lesion that had diffusely spread throughout the remnant intrahepatic bile duct (Fig. 3a). Percutaneous transhepatic biliary drainage was performed, and a drainage stent was placed within the hepatic duct of segment 5 (B5), which was filled with recurrent tumors (Fig. 3b). Internal drainage stents were placed within B5 and B8 across the anastomosis (Fig. 3c), after which the patient was discharged.