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Kang, Kim, Byun, Oh, Park, Kim, Jo, and Lee: Metastatic Small Bowel Perforation Caused by Intrahepatic Cholangiocarcinoma in a Patient with Combined Hepatocellular-cholangiocarcinoma
Case Report
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 77(2): 138-142.

Published online: 4 August 2009

DOI: https://doi.org/10.4174/jkss.2009.77.2.138

Metastatic Small Bowel Perforation Caused by Intrahepatic Cholangiocarcinoma in a Patient with Combined Hepatocellular-cholangiocarcinoma

Dong Baek Kang, M.D., Seung Ho Kim, M.D., Seung Jae Byun, M.D., Jung Taek Oh, M.D., Won Cheol Park, M.D., Kang Deuk Kim, M.D.1, Hyang Jeong Jo, M.D.2, Jeong Kyun Lee, M.D.

Department of Surgery, Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea.

1Department of Radiology, Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea.

2Department of Pathology, Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea.

Corresponding author (rjk@wonkwang.ac.kr)

Received 30 January 2009       Accepted 18 February 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Advances in chemotherapy and radiation therapies for malignant tumors have resulted in the identifications of various novel features of intestinal metastasis. The common causes of small bowel metastasis are malignant melanoma and lung cancer, and this has also been rarely reported to uterine cervical cancer, malignant lymphoma of the larynx, malignant lymphoma of soft palate, and hepatocellular carcinoma (HCC). The Combined HCC-cholangiocarcinoma (HCC-CC) is a rare primary liver malignancy, and is composed of cells with the histopathological features of both HCC and CC, but metastatic small bowel perforation by CC in a patient with combined HCC-CC has not been reported previously. The authors describe the case of a 51-year-old man with a metastatic small bowel perforation caused by an intrahepatic CC in combined HCC-CC with a review of the literature.

Keywords: Small bowel perforation, Metastasis, Combined hepatocellular-cholangiocarcinoma

Figures and Tables

Fig. 1
Typical hepatocellular carcinoma in a cirrhotic patient (A), and mass-forming intrahepatic cholangiocarcinoma (B). (A) Arterial-phase contrast-enhanced CT scan showing a 2.8 cm sized well-defined contrast enhancement and washout of contrast on delayed-phase (arrow). (B) Arterial-phase contrast-enhanced CT scan shows a low-attenuation mass at the lateral segment of the liver (arrow), and the mass appeared more enhanced with dilatation of peripheral intrahepatic ducts on a portal phase (arrowheads).
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Fig. 2
Operative findings showing a 1 cm sized small bowel perforation on the mesenteric border 70 cm above the ileocecal valve with intra-luminal stricture at perforation (arrow), and multifocal nodules at mesentery (arrowheads).
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Fig. 3
Histopathological findings of the perforated small bowel showing all layers involved tubular pattern of the metastatic carcinoma. This finding was duplicated in the mesentery and omentum (H&E, ×200).
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Fig. 4
Immunohistochemical findings of the metastatic tumor. HepPar-1 (a hepatocyte marker) (A) and CK20 (B) were negative, CK7 (C) and CK19 (D) (both cholangiocyte markers) were positive, indicating that it probably originated from cholangiocarcinoma (H&E, ×200).
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