Rapid progression of intrahepatic cholangiocarcinoma after drainage of large cystic lesions: report of a case.

We report herein a case of cholangiocarcinoma with large cystic lesions. Computed tomography (CT) demonstrated large cysts in segment IV and the paracaval portion of the caudate lobe, and a solid tumor in the anterior segment of the right lobe of the liver which was contiguous to the cyst in the paracaval portion of the caudate lobe. The large cysts were diagnostically misleading and a liver abscess was suspected. Thus, percutaneous transhepatic drainage of the cyst was performed. The fluid in the cyst was negative bacteriologically, but malignant cells were detected. A CT scan done 2 weeks after drainage of the cyst showed progression of the solid tumor with intrahepatic metastasis and replacement of the cystic lesions by the solid tumor. Following percutaneous transhepatic portal embolization, a right hepatic trisegmentectomy with caudate lobectomy was performed. Pathological examination confirmed cholangiocellular carcinoma. These results indicate that drainage of the cystic lesion induced the tumor progression in the liver. Therefore, the possibility of cholangiocarcinoma with a large cystic lesion should be borne in mind when considering the differential diagnosis of a cystic lesion in the liver, and appropriate surgical therapy should be carefully selected.