腹腔鏡下に発見された肝内胆管腺腫の1例

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  • A CASE OF INTRAHEPATIC BILE DUCT ADENOMA DETECTED BY LAPAROSCOPY

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A 43-year-old Japanese male was admitted to our hospital because of a thorough examination of the liver. Abdominal US and CT revealed an enlarged and fatty liver but no findings suggestive of hepatic tumors. Laparoscopy disclosed an enlarged, whitish liver with irregular surface, and a round shaped, slightly elevated whitish focal lesion which was clearly demarcated, 4mm in size, on the left lobe of liver near the falciform ligament. Fine vessels were observed on the surface of this lesion. This lesion was not stainned after ICG (indocyanine green) injection. Histology of the biopsied lesion showed adenomatous bile duct among dense fibrous tissues, which were compatible with intrahepatic bile duct adenoma. The second laparoscopy, 2 years later, disclosed a whitish scarred lesion at the site where a tumor was located previously. It seems due to the effect of biopsy performed from the tumor at the first laparoscopy. Intrahepatic bile duct adenoma is rarely en-countered in clinical practice, and only 8 cases have been reported in Japan. Most of them were incidentally found on abdominal surgery or autopsy. It is a benign tumor and, therefore, it has been dealt as a clinically negligible disease. However, there may be more opportunities to find these lesions with the development of diagnostic modalities and intrahepatic bile duct adenoma should be borne in mind in the diagnosis of focal hepatic lesion.

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