A 64-year-old man was investigated for long-standing, vague, epigastric abdominal pain. His pain had a recurring and relapsing time course. He had a history of peptic ulcer disease, hypertension and insulin-dependent , and he had undergone a laparoscopic cholecystectomy in the previous year. The patient had no history of jaundice, liver disease, hepatitis or alcohol abuse. His physical examination was normal. He was investigated with colonoscopy, chest x-ray, abdominal ultrasound, liver function tests and alpha-fetoprotein, all of which were normal. His hepatitis serology was negative. A computed tomography (CT) scan revealed a small, 2 cm heterogeneous focal mass in segment 2 of the liver. After consultation with the patient, expectant management of the liver lesion was undertaken. Follow-up ultrasound and a triphasic CT scan six months later revealed a progression; the hypovascular, hypoechoic liver mass had increased to 5.6 cm in greatest diameter. The mass was found overlying the umbilical fissure between segments 2, 3 and 4 (Figure 1). Centrally, part of the lesion was vascular, and the periphery was hypovascular. There was mild distal bile duct dilation in segments 2 and 3. Given the interval change in size and concern that this represented a malignancy, surgical resection was recommended.
Well-differentiated intrahepatic cholangiocarcinoma in the setting of biliary papillomatosis: CASE PRESENTATION (Part 1)
October 1st, 2012