Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2012 Jan 25:10:22.
doi: 10.1186/1477-7819-10-22.

Anatomical liver segmentectomy 2 for combined hepatocellular carcinoma and cholangiocarcinoma with tumor thrombus in segment 2 portal branch

Hiromichi Ishii  1 , Takuma Kobayashi, Michihiro Kudou, Masumi Nishimura, Atsushi Toma, Kenji Nakamura, Takeshi Mazaki, Tsuyoshi Itoh
Affiliations
Case Reports

Anatomical liver segmentectomy 2 for combined hepatocellular carcinoma and cholangiocarcinoma with tumor thrombus in segment 2 portal branch

Hiromichi Ishii et al. World J Surg Oncol. .

Abstract

Background: Hepatic resection is the only effective treatment for combined hepatocellular carcinoma and cholangiocarcinoma.

Case presentation: A 52-year-old man was preoperatively diagnosed with hepatocellular carcinoma in segment 2 with tumor thrombus in the segment 2 portal branch. Anatomical liver segmentectomy 2, including separation of the hepatic arteries, portal veins, and bile duct, enabled us to remove the tumor and portal thrombus completely. Modified selective hepatic vascular exclusion, which combines extrahepatic control of the left and middle hepatic veins with occlusion of left hemihepatic inflow, was used to reduce blood loss. A pathological examination revealed combined hepatocellular carcinoma and cholangiocarcinoma with tumor thrombus in the segment 2 portal branch. No postoperative liver failure occurred, and remnant liver function was adequate.

Conclusion: The separation method of the hepatic arteries, portal veins, and bile duct is safe and feasible for a liver cancer patient with portal vein tumor thrombus. Modified selective hepatic vascular exclusion was useful to control bleeding during liver transection. Anatomical liver segmentectomy 2 using these procedures should be considered for a patient with a liver tumor located at segment 2 arising from a damaged liver.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Dynamic computed tomography revealed a tumor in segment 2 of the liver, which was high and low density in the arterial (a) and venous phases (b), respectively, and portal vein tumor thrombus in the portal branch root of segment 2 (arrow) (c). Portal vein tumor thrombus did not invade to umbilical and transverse portions (UP and TP) of the left portal vein (d, e). P3, portal branch of segment 3; LHV, left hepatic vein.
Figure 2
Figure 2
Left hepatic arteries of segment 2 (A2) and 3 (A3), umbilical and transverse portions (UP and TP) of the left portal vein, and portal branch of segment 2 (P2) were encircled (a). Segment 2 and remnant liver were connected only through the portal branch and bile duct of segment 2 (P2 and B2) (b). LHA, left hepatic artery. LHV, left hepatic vein.
Figure 3
Figure 3
Portal vein tumor thrombus (PVTT) in the segment 2 portal branch (P2) (a). Microscopically, the tumor was combined hepatocellular carcinoma and cholangiocarcinoma (Hematoxylin and eosin staining; magnification ×10) (b).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Goodman ZD, Ishak KG, Langloss JM. Combined hepatocellular cholangiocarcinoma. A histologic and immunohistochemical study. Cancer. 1985;55:124–135. doi: 10.1002/1097-0142(19850101)55:1<124::AID-CNCR2820550120>3.0.CO;2-Z. - DOI - PubMed
    1. Jarnagin WR, Weber S, Tickoo SK, Koea JB, Obiekwe S, Fong Y, DeMatteo RP, Blumgart LH, Klimstra D. Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors. Cancer. 2002;94:2040–2046. doi: 10.1002/cncr.10392. - DOI - PubMed
    1. Yano Y, Yamamoto J, Kosuge T, Sakamoto Y, Yamasaki S, Shimada K, Ojima H, Sakamoto M, Takayama T, Makuuchi M. Combined hepatocellular and cholangiocarcinoma: a clinicopathologic study of 26 resected cases. Jpn J Clin Oncol. 2003;33:283–287. doi: 10.1093/jjco/hyg056. - DOI - PubMed
    1. Liu CL, Fan ST, Lo CM, Ng IO, Lam CM, Poon RT, Wong J. Hepatic resection for combined hepatocellular and cholangiocarcinoma. Arch Surg. 2003;138:86–90. doi: 10.1001/archsurg.138.1.86. - DOI - PubMed
    1. Park H, Choi KH, Choi SB, Choi JW, Kim do Y, Ahn SH, Kim KS, Choi JS, Han KH, Chon CY, Park JY. Clinicopathological characteristics in combined hepatocellular-cholangiocarcinoma: a single center study in Korea. Yonsei Med J. 2011;52:753–760. doi: 10.3349/ymj.2011.52.5.753. - DOI - PMC - PubMed

Publication types

MeSH terms