Biliary cystadenocarcinoma resected by segment 3 and 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. Laboratory data showed an elevation of alkaline phosphatase and a decreased excretion of Indocyanine green (ICG). CT revealed a cystic tumor with papillary projections, measuring 13A approximately 15cm, in the left medial segment of the liver (S4). Percutaneous transhepatic cholangioscopy (PTCS) disclosed the tumor in the dorsal subsegmental duct of S4 and the cholangioscopic biopsy from the tumor revealed papillary adenocarcinoma. PTCS showed the left lateral posterior segmental bile duct (B2) joined the common tract of the left medial (B4) and left lateral anterior (B3) segmental bile duct, and the tumor involved B4 and 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 hepatic duct and the segment 2 was performed. The histopathological examination revealed that the tumor did not involve the liver parenchyma and 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 evaluation by PTCS for a rational surgical procedure.