PMC4532018_01
Dynamic abdominal C-T scan showed an enhancing mass at the hepatic hilus (arrows), liver cirrhosis and splenomegaly without focal lesion in the hepatic parenchyma.
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A dynamic abdominal CT scan showed an enhancing mass at the hepatic hilus, liver cirrhosis and splenomegaly without focal lesion in hepatic parenchyma (Fig. 1).
Endoscopic retrograde cholangiography (A) revealed a 3x2 cm sized, oval shaped, smooth surfaced filling defect (arrows) at the upper common hepatic duct including the porta hepatis. Note bulging of the upper common hepatic duct and the bulged and dilatation of the intrahepatic ducts. On percutaneous transhepatic cholangiography (B), the mass appeared somewhat lobulated and had shallow grooves on the surface.
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The surface of the mass was smooth and the upstream intrahepatic bile ducts were slightly dilated (Fig. 2A). On a percutaneous transhepatic cholangiography (PTC) (Fig. 2B), through a percutaneous transhepatic biliary drainage (PTBD) tube, dye was well passed over the obstructing mass.
Microscopically, the tumor was located in the bile duct lumen (A, H&E, x100). The tumor cells appeared as nests in pseudoacinus patterns (B, H&E, x100) and bile pigment was found in the cytoplasm (C, H&E, x400).
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Microscopically, tumor cells appeared as nests in pseudoacinus patterns, and bile pigment was found in the cytoplasm (Fig. 3A, 3B, 3C).
The immunohistochemical stain demonstrated positive reaction for alpha-fetoprotein (A, x100) but negative reaction for carinoembryonic antigen (B, x40).
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The immunohistochemical stain demonstrated positive reaction for alpha-fetoprotein but negative reaction for carinoembryonic antigen (Fig. 4A, 4B).
A follow-up ultrasound examination performed at postoperative 6 months disclosed two small hypoechoic lesions at the segment 8 (A) and the segment 5 (B).
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About 6 months after the operation, a follow-up ultrasound examination disclosed two small hypoechoic lesions (1.2-1.5 cm in diameter) at the segment 8 and the segment 5 (Fig. 5A, 5B).
CT arterioportography taken at postoperative 6 months suggested two low density lesions at the segment 8 (A) and the segment 5 (B) of the liver.
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Tumor staining was not found on hepatic angiography, but two low density lesions were suspected at the segment 8 and the segment 5 on CT arterioportography (Fig. 6A, 6B).
Lipiodol-CT taken 3 weeks after CT arterioportography revealed no remaining lipiodol on the corresponding portions of the liver (A, B).
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However, no lipiodol remained on lipiodol-CT taken 3 weeks later (Fig. 7A, 7B).