PDF(Pubmed)
Abstract：
Colorectal liver metastasis (CRLM) appears in 25-50% of patients with colorectal cancer (CRC). However, CRLM with bile duct tumor thrombus (BDTT) is rare and often diagnosed after surgical resection. We report a case of CRLM associated with BDTT in a 79 year-old woman. She underwent sigmoid colectomy for sigmoid colon carcinoma at the age of 64. Fifteen years later, abdominal computed tomography revealed a liver tumor with a biliary tumor thrombus in segment IV/V and localized dilation of the intrahepatic bile duct. Additionally, magnetic resonance imaging confirmed a tumor in liver segment IV/V and mass in the bile duct (B4). Extended left hepatic lobectomy was performed under the diagnosis of intrahepatic cholangiocarcinoma or metastatic liver tumor with tumor development in the intrahepatic bile duct. The resected specimen showed significant cancer infiltration into the intrahepatic bile duct (B4), forming a tumor thrombus. The tumor was a moderately differentiated adenocarcinoma, histologically similar to sigmoid colon cancer. CRLM with BDTT may have a relatively low invasive potential of malignancy with a long interval after primary resection. When a patient with a history of CRC presents with BDTT, the possibility of CRLM with BDTT and surgical treatment should be considered, because resection could lead to a good prognosis. It is important to ensure a secure surgical margin in the bile ducts during surgery and anatomical hepatic resection should be considered.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s13691-022-00583-6.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s13691-022-00583-6.
摘要：
25-50％的结直肠癌（CRC）患者出现结直肠肝转移（CRLM）。然而,CRLM伴胆管癌血栓（BDTT）罕见，常在手术切除后诊断。我们报告了一名79岁女性的CRLM与BDTT相关的病例。她在64岁时因乙状结肠癌接受了乙状结肠切除术。十五年后,腹部计算机断层扫描显示肝肿瘤，IV/V段有胆道肿瘤血栓，肝内胆管局部扩张。此外,磁共振成像证实肝IV/V段肿瘤和胆管肿块（B4）。在诊断为肝内胆管癌或转移性肝肿瘤并在肝内胆管发展的情况下，进行了扩大的左肝叶切除术。切除标本显示明显的癌浸润到肝内胆管（B4），形成肿瘤血栓.肿瘤是中分化腺癌,组织学类似乙状结肠癌。带有BDTT的CRLM可能具有相对较低的恶性侵袭潜力，在初次切除后间隔较长。当具有CRC病史的患者出现BDTT时，应考虑CRLM联合BDTT和手术治疗的可能性，因为切除可以导致良好的预后。重要的是在手术期间确保胆管的安全手术边缘，并且应考虑解剖性肝切除术。
UNASSIGNED：在线版本包含补充材料，可在10.1007/s13691-022-00583-6获得。
UNASSIGNED：在线版本包含补充材料，可在10.1007/s13691-022-00583-6获得。
