A RESECTED CASE OF INTRAHEPATIC CHOLANGIOCARCINOMA DETECTED 9 YEARS AFTER OPERATION FOR DOUBLE CANCER OF THE STOMACH AND PANCREAS

Abstract

We have experienced a resected case of intrahepatic cholangiocellular carcinoma of peripharal type oc-curred 9 years after an operation for synchronous double cancer of the stomach and pancreas. A 74-year-old man revealed an increase in level of a tumor marker (CA 19-9:267IU/ml) during medical ovservation following the operation for the double cancer on an ambulant basis. Abdominal CT scanning visu-alized a tumor 3cm in diameter presenting an irregular low density area in the anterior and superior segment of the right lobe (S 8) of the liver. From findings of CT, ultrasonography, and angiography, we found a great deal of difficulty in differentiating whether the hepatic tumor was metastatis of the former gastric or pancreatic cancer or intrahepatic cholangiocellular carcinoma. But we first considered it as intrahepatic cholangiocel-lular carcinoma because it was solitary and 9 years had elapsed after the inital operation, and performed a segmentectomy (S 8) of the liver. The resected material also demonstrated intrahepatic cholangiocellular carcinoma of peripheral type, histopathologically. It is very rare that metachronous triple cancer appears in such combination as early gastric cancer, pan-creatic cancer and intrahepatic cholangio-cellular carcinoma, and hence this case is presented here.