BILIARY CYSTADENOCARCINOMA RESECTED BY SEGMENT-3 AND SEGMENT-4 HEPATECTOMY

We describe a case of biliary cystadenocarcinoma of the liver in a 72 year-old woman. presented to our hospital with abdominal fullness. Lab oratory data showed an elevation of alkaline phosphatase and a decreas ed excretion of Indocyanine green (ICG). CT revealed a cystic tumor wi th papillary projections, measuring 13 Angstrom similar to 15cm, in th e left medial segment of the liver (S4). Percutaneous transhepatic cho langioscopy (PTCS) disclosed the tumor in, the dorsal subsegmental duc t of S4 and the cholangioscopic biopsy from the tumor revealed papilla ry adenocarcinoma. PTCS showed the left lateral posterior segmental bi le duct (B2) joined the common tract of the left medial (B4) and left lateral anterior (B3) segmental bile duct, and the tumor involved B4 a nd B3 but not the common tract of B4 and B3. A radical surgery, which included segment 4 and 3 resection. with preservation of the left hepa tic duct and the segment 2 was performed. The histopathological examin ation, revealed that the tumor did not involve the liver parenchyma an d had no lymph node metastasis. Postoperative course was unremarkable and the patient at present time, 4 years after the operation, is doing well. This case report discusses the importance of preoperative evalu ation by PTCS for a rational surgical procedure.