Successful Preoperative Diagnosis and Complete Resection of Biliary Intraductal Papillary-Mucinous Neoplasm of the Liver

Abstract

CASE REPORT A 59-year-old man was admitted to our hospital for further examination of an asymptomatic cystic tumor in the liver. On admission, he was not jaundiced, and the mass was not palpable in his abdomen. Laboratory evaluation did not demonstrate any abnormalities. Serum carcinoembryonic antigen level was within the normal range, but the carbohydrate antigen 19-9 level was elevated at 221 U/ml (normal range 3 to 25 U/ml). Abdominal ultrasonography and CT demonstrated a multilocular cystic tumor in the left lobe of the liver measuring 5 cm without mural nodules (Fig. 1). Endoscopic retrograde cholangiography showed a widely opened Vater’s ampulla and dilated common bile duct measuring 25 mm with filling defects containing mucus. The left hepatic and intrahepatic bile ducts in the left hepatic lobe were not visualized. No apparent communication was present between the cystic tumor and the bile ducts. Cytology of the biliary juice was examined three times, and diagnosed as showing borderline malignancy. Under a diagnosis of biliary intraductal papillarymucinous neoplasm localized in the left lobe of the liver with possible malignant transformation, left hemihepatectomy with lymphadenectomy in the hepatoduodenal ligament was performed. The resected specimen macroscopically showed multiple saccular dilatations of the intrahepatic biliary tree containing mucous fluid in the left lobe of the liver (Fig. 2). Subsequent pathological examination demonstrated that the tumor was a biliary intraductal papillarymucinous adenocarcinoma. The internal surface of the dilated biliary tree consisted of high columnar epithelium with mucin-producing cells and a partly