Intrahepatic cholangiocarcinoma with clear cell type following laparoscopic curative surgery - PubMed (original) (raw)

Intrahepatic cholangiocarcinoma with clear cell type following laparoscopic curative surgery

Takuya Yamamoto et al. Surg Case Rep. 2020.

Abstract

Background: Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy of primary liver cancer. Among the several pathological types of ICC, only five cases of the clear cell type have been reported, including the one presented below. Here we report a unique case of clear cell type ICC following laparoscopic hepatectomy.

Case presentation: A 67-year-old woman had a history of hepatitis B virus. Computed tomography revealed a ring-like enhanced mass 35 mm in diameter at segment 7 in the early phase. The enhancement was prolonged to the late phase through the portal phase, while the shape was irregular. Ethoxybenzy magnetic resonance imaging revealed that the tumor had a low signal intensity on T1-weighted imaging and a high signal intensity on T2-weighted imaging. Diffusion-weighted images identified that the tumor had remarkably high signal intensity. Tumor enhancement was not detected throughout the tumor in the hepatocyte phase. Upon ICC diagnosis, a laparoscopic S7 subsegmentectomy was performed. The patient's postoperative course was uneventful. An immunohistochemical examination revealed that the cells tested positive for cytokeratin 7 (CK7), CK19, and CD56 and negative for CK20, CD10, α-fetoprotein, thyroid transcription factor-1. At 2 years after surgery, the patient remains alive without recurrence.

Conclusions: Here we presented a case of clear cell ICC that was treated by laparoscopic hepatectomy. Immunological analysis, especially by CD56 and several CK markers, is helpful for diagnosing this disease.

Keywords: Clear cell type; Intrahepatic cholangiocarcinoma; Laparoscopic hepatectomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Fig. 1

Findings of dynamic abdominal computed tomography. a The arterial phase showing a ring-like enhanced mass at segment 7 measuring 35 mm in diameter shaped like an irregular arrow. b Portal phase. c The enhancement was prolonged to the late phase

Fig. 2

Fig. 2

Findings of magnetic resonance imaging (MRI). a The tumor shows a low signal intensity on a T1-weighted image. b The tumor shows a high signal intensity on a T2-weighted image. c At the early phase on ethoxybenzyl magnetic resonance imaging (EOB-MRI), the tumor shows ring-like enhancement. d The enhancement is not detected throughout the tumor in the hepatocyte phase on EOB-MRI

Fig. 3

Fig. 3

Imaging. a Gross appearance of the cut surface showing a solid whitish mass measuring 35 mm × 32 mm × 30 mm with irregular margins. In the area surrounded by the black line on a and b, clear cells are abundantly clear

Fig. 4

Fig. 4

Histopathological findings. a, b The tumor consists of poorly differentiated adenocarcinoma tissue (a) and clear cells with atypical nuclei (b) (hematoxylin and eosin stain); c CK7 expression is positive; d CK19 expression is positive; e CD56 expression is positive; f CK20 expression is negative; g CD10 expression is negative; h α-fetoprotein expression is negative; i thyroid transcription factor-1 expression is negative

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