Huge subcapsular hematoma caused by intrahepatic sarcomatoid cholangiocarcinoma

Intrahepatic sarcomatoid cholangiocarcinomais is a very rare disease with a poor prognosis due to its biologically aggressive tumor behavior. We report a patient who presented with subcapsular hemorrhage and a rapidly growing liver mass. A 57 year-old man was admitted with severe abdominal pain. CT and MRI images showed the presence of a 10 cm-sized subcapsular hemorrhage connected with a multi-lobulated mass with hemorrhage and necrotic foci in the right liver. The patients underwent right hemihepatectomy with caudate lobectomy and lymphadenectomy. The operation findings revealed metastatic nodules to the diaphragm and omentum. Detailed histopathological analysis through immunohistochemistry confirmed the diagnosis of sarcomatoid cholangiocarcinoma with a poorly undifferentiated sarcomatous component. The patient underwent chemotherapy. To date, the patient is doing well for 8 months after initial diagnosis.

The Result of Operative Treatment and Clinical Characteristics of the Intrahepatic Duct Stone Patients / 한국간담췌외과학회지

The intrahepatic duct (IHD) stone shows diverse spectrum of clinical features such as recurrent cholangitis, obstructive jaundice, liver abscess, biliary cirrhosis and association with cholangiocarcinoma. The result of operative treatment is still not satisfied in spite of many kinds of surgical treatment modalities. The purpose of this study is to elucidate the clinical characteristics and the operative principle of IHD stone by the reviewing the medical records, retrospectively. The 61 patients who received operation at the Department of Surgery, Chungbuk National University Hospital were included in this study. The mean age of the patients is 56 and the age of predilection is sixth and seventh decade. The incidence of IHD stone is higher in females, with a female-to-male ratio of 2.6:1. All of the patients experienced cholangitis more than one episode before operation. The location of IHD stone was 31 patients in left, 8 patients in right, and 21 patients in both IHD. Liver resection was preferred to drainage procedure when the stones were limited to one lobe or segment. 46(75%) cases of liver resection, 11(18%) drainage procedure, 2(3%) T-tube choledocholithomy and 2(3%) open biopsy were performed. Residual stones were found 8 patients(17%) on the liver resection group, 8(61%) on the drainage procedure or T-tube choledocholithotomy group. The patients who had stones in one lobe or limited in the localized part of the liver showed residual stones in one (3%) patients after liver resection. Seven patients(44%) of both IHD stone group who received liver resection, however, had residual stones. There was no postoperative mortality in the liver resection group. IHD stone-associated cholangiocarcinoma was found in 6 patients(10% of studied patients). Three of them were diagnosed during IHD stone operation. The rest was detected after operation(1 - 5 years). Liver resection is the treatment of choice of IHD stone considering residual stones and association with cholangiocarcinoma, especially. These data also suggest that longterm follow-up of the IHD stone patients is needed because of cholangiocarcinoma.