| Objective:To summarize and analysis the clinical characteristics of intrahepatic cholangiocarcino-ma,and then compared with hepatocellular carcinoma.With this study,we hope that it enhance the level of the diagnosis and treatment of ICC.Methods:In this study,we collected40cases of ICC patients’data and selected80cases of HCC randomly in the same period as control in the Department of Hepatobiliary-Pancreatic Surgery,Shandong Provincial Hospital from March2004to November2011.All120cases patients underwent surgical procedure and obtained histopathologic diagnosisi.For the clinical date obtained,we performed a retrospective study including data of etiology, pathogenesis,diagnosis, treatment and outcome and other aspects.Results:Studying the clinical data of ICC and HCC,we found that ICC is more likely to occur in the women.ICC patients were more often with a history of cholelithiasis or with cholelithiasis when they were ill of ICC than HCC,and cholelithiasis and tumors were often located in the same side of the liver.The abdominal pain is often the main symptom of ICC patients.In the late phase,if the widely metastasis happened, the symptom of obstructive jaundice will occur. The abdominal pain will be worse and more difficult in alleviating.ICC usually occurs in the left lobe of the liver.The HbsAg positive rate of ICC is lower than HCC.The AFP positive rate and detection of ICC are significantly lower than HCC.The positive rate of CA199of ICC,the increased number of case and the detection value are significantly higher than HCC. Related imaging tests:here are intrahepatic low-density space-occupying lesions lobulated or integrated with cholelithiasis on CT scan; on contrast-enhanced CT,at the aterial phase,high signal was not obvious, but at the late phase, the lesion edge showed slightly high signal. But the tumor is poorly circumscribed and the bile duct around the tumor reveals dilation. This is another significant feature of ICC. For some cases in advanced stage,the border between tumor and the stomach and other organs is not clear.The T1WI demonstrated low signal and the T2WI demonstrated high signal. If the central scar consists mainly of fibrous tissues, both on T1WI and T2WI demonstrated low signals.If the central scar consists of necrosis tissue with much mucus,then T2WI demonstrated significantly higher signals.On contrast-enhanced scanning,at the early phase, high signal was not obvious, but at the late phase, the lesion edge showed a slightly higher signal.But the tumor is poorly circumscribed and the bile duct around the tumor reveals dilation in ICC patients. ICC usually presents enlarged abdominal lymph nodes.ICC invades the diaphragm, pericardial, gastric wall,and surrounding organs more easily.ICC is highly malignant with high rate of abdominal lymph node metastasis and the preoperative diagnosis is difficult, which brings a high misdiagnosis rate.Conclusion:1. ICC occurs more often in females with old age and is more likely to occur in the left lobe liver. Cholelithiasis with recurrent infection of biliary tract may be one of the causes of ICC.2. CA199, AFP, and CT and MRI and other imaging examination are helpful to the differential diagnosis of ICC and HCC.3. ICC is a high-grade malignant tumor and extrahepatic metastasis is common. It often violates the surrounding organs and tissues or with metastasis of extrahepatic lymph node. 4. The treatment of ICC mainly depends on surgery. We should adopt the surgical way of completely resecting the liver lesion plus the multi-line abdominal lymph node sweeping.5.ICC and HCC are both intrahepatic malignancies, but with completely different clinical features. We should study the two diseases separately. It would be help in clarifying the diagnosis and treatment principles of ICC and improving the prognosis of ICC. |
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