Clinico-pathological findings of asymptomatic intrahepatic cholangiocellular carcinoma: report of two cases and review of the literature.

The prognosis of intrahepatic bile duct carcinoma (cholangiocellular carcinoma: CCC) is extremely poor unless detected at an early and curable stage. However, little is known about the clinico-pathological features of CCC resected at a symptom-free stage. We herein report the clinico-pathological findings in two asymptomatic patients who underwent resection. Their liver function tests showed elevated levels of gamma-glutamyl transpeptidase. An intrahepatic mass was first detected by ultrasonography, and subsequent direct cholangiography and cytological examination revealed the presence of carcinoma in both patients. Left or right hepatic lobectomy with caudate lobectomy and lymph node dissection with or without resection of the extrahepatic bile duct was carried out. The lesions were 2.5 and 2.8 cm in maximal size, originating from the intrahepatic bile duct of segment IV and I, respectively. Both were free from extrahepatic bile duct involvement, intrahepatic and lymph node metastases. However, even in a symptom-free stage, perineural invasion, vascular or lymphatic involvements were histologically proved in both cases, which may be an indication of poor prognosis after surgery alone.