%0 Journal Article
%T Unclassified Diffuse Ductal Cholangiocarcinoma; Report of a Case
%A ¨¹nal Ayd£¿n
%A £¿smail £¿zsan
%A T¨¹rker Karabu£¿a
%A £¿zcan Alpdo£¿an
%A Rag£¿p Orta£¿
%A £¿mer Yolda£¿
%A Erkan £¿ahin
%J Case Reports in Surgery
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/542849
%X Cholangiocarcinoma (CCA) is the second most common malignant tumor of the liver. It is simply classified as intrahepatic and extrahepatic CCA (including perihilar and distal extra hepatic CCA) according to the anatomic localization. Various classification systems were described for staging cholangiocarcinoma. We represent an interesting case of cholangiocarcinoma which is in the shadow area of classification by involving intrahepatic, hilar, and distal extra hepatic bile ducts. To our knowledge, this is the first case in the literature with diffuse bile duct involvement. 1. Introduction Cholangiocarcinoma is the second most common primary tumor of the liver. Cholangiocarcinomas are classified according to their anatomic location as intrahepatic and extrahepatic. The anatomic margins for distinguishing intra- and extrahepatic cholangiocarcinomas are the second order bile ducts. Therapeutic modalities vary according to the localization of the tumor. Extrahepatic cholangiocarcinomas can further be subdivided according to the Bismuth classification into types I to IV. As in Bismuth classification various terminologies and classifications have been used to describe the pathologic and radiologic appearance of cholangiocarcinoma and each describes a specific aspect of the tumor. The Liver Cancer Study Group of Japan proposed in 2000 a new classification based on growth (morphologic) characteristics being identified as mass forming, periductal-infiltrating, and intraductal-growing types [1]. Characteristically skipping involvements towards the biliary tract should be observed in cholangiocarcinoma. Here we represent a case which remains unclassified anatomically with the involvement of intrahepatic, perihilar, and distal extrahepatic bile ducts and the patients¡¯ intraoperative management. 2. Case 2.1. Preoperative Workup A 36-year-old man was referred to our hospital with a diagnosis of obstructive jaundice due to distal cholangiocarcinoma. On admission he had a history of jaundice, itching, and 10£¿kg loss in weight. Regarding biochemical analyses, aspartate aminotransferase level was 100£¿U/L, alanine aminotransferase was 106£¿U/L, alkaline phosphatase was 176£¿U/L, gamma-glutamyl transpeptidase was 134£¿U/L, and bilirubin level was 1,7£¿mg/dL. Abdominal ultrasonography revealed minimal choledochal dilatation. Asymmetric contrast-enhancing lesion in distal choledoch, indentation to portal vein, and minimal wall thickness were observed in abdominal magnetic resonance imaging (Figures 1(a) and 1(b)). Endoscopic retrograde cholangiopancreatography (ERCP) revealed a
%U http://www.hindawi.com/journals/cris/2014/542849/