PMC3275512_01
Dynamic computed tomography revealed a tumor in segment 2 of the liver, which was high and low density in the arterial (a) and venous phases (b), respectively, and portal vein tumor thrombus in the portal branch root of segment 2 (arrow) (c). Portal vein tumor thrombus did not invade to umbilical and transverse portions (UP and TP) of the left portal vein (d, e). P3, portal branch of segment 3; LHV, left hepatic vein.
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F1
Abdominal dynamic computed tomography (CT) revealed a high- and low-density lesion in the arterial and venous phases, respectively (Figure 1a and 1b). CT also revealed PVTT in the root of P2 (Figure 1c), excluding the umbilical and transverse portion of the left portal vein (Figure 1d and 1e).
Left hepatic arteries of segment 2 (A2) and 3 (A3), umbilical and transverse portions (UP and TP) of the left portal vein, and portal branch of segment 2 (P2) were encircled (a). Segment 2 and remnant liver were connected only through the portal branch and bile duct of segment 2 (P2 and B2) (b). LHA, left hepatic artery. LHV, left hepatic vein.
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F2
The left hepatic arteries of segment 2 (A2) and 3 (A3) were encircled at the left side of the umbilical portion of the left portal vein after thorough mobilization, and encircling of the umbilical and transverse portions of the left portal vein and P2 by sacrificing one of the portal branches supplying segment 1 (Figure 2a). After liver transection, segment 2 and the remnant liver were connected through only P2 and the segment 2 bile duct (B2) (Figure 2b).
Portal vein tumor thrombus (PVTT) in the segment 2 portal branch (P2) (a). Microscopically, the tumor was combined hepatocellular carcinoma and cholangiocarcinoma (Hematoxylin and eosin staining; magnification x10) (b).
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F3
Macroscopically, PVTT was found in P2, and the surgical margin of PVTT was 1 mm (Figure 3a). Microscopically, the tumor was composed of HCC with trabecular structure and adenocarcinoma (Figure 3b), suggesting cHCC-CC.