A resected case of cholangiocellular carcinoma with primary intrahepatic bile duct stones: Immunohistochemical study of epitherial cell proliferation in the intrahepatic bile ducts

A 63-year-old female was admitted to our hospital due to right hypochondralgia in May 1988. Laboratory data showed slight dysfunction of liver function test with 90U/ml of CA19-9. Imaging studies of CT, US and direct cholangiogram revealed impacted intrahepatic bile duct stones in the right lobe but no malignant tumor was detected in the liver. Intraoperative histological examination of the frozen section of a lymph node in the hepatoduodenal ligament indicated the metastatic adenocarcinoma. Extended hepatic lobectomy with dissection of the regional lymph nodes was performed. An elevated lesion was revealed after removal of stones in the dilated duct wall in the anterior segment and histological study showed moderately differentiated papillary adenocarcinoma of the intrahepatic bile duct. Immunohistochemical study using a monoclonal antibody to bromodeoxyuridine showed 8.6% of labeling index in the elevated lesion and 8.8% in the non-cancerous epithelia of its neighbouring duct wall, and 0.5% in the wall of the narrowed bile duct in the hilum and 0.3% in the right hepatic duct.