Adenosquamous carcinoma with different morphologic and histologic components arising from the intrahepatic bile duct: report of a case.

A very rare form of adenosquamous carcinoma arising from the intrahepatic bile duct which had diverse morphologic and histologic components is presented. A 77-year-old female complained of relapsing febrile attack accompanied by upper abdominal pain. From the imaging studies, which revealed an atrophic left lobe with dilated intrahepatic bile duct, cholangiocarcinoma constricting the orifice of B3 was considered the most likely diagnosis. Surgery, which included resection of the left hepatic and caudate lobes with lymph node dissection, revealed an atrophic lateral segment indicating recurrent inflammation. Pathologic examination revealed a combined tumor composed of papillary squamous cell carcinoma arising at the orifice of the lateral inferior segmental bile duct and intramucosal adenocarcinoma spreading distal to the polypoid tumor. Two different components were connected with a thin stalk, but there was no apparent transitional zone. Contrary to ordinary mass-forming adenosquamous carcinoma in the liver, which is reported to pursue a very rapid, fatal course, our patient made an uneventful recovery and has remained in good health without recurrence for 2 years and 3 months since surgery.