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Background The aim of this study was to clarify prognostic factors and recurrence patterns in patients with node-negative intrahepatic cholangiocarcinoma (IHCC). Methods A retrospective study was performed to review prognostic factors and recurrence patterns (1) in 22 patients with node-negative IHCC after curative hepatic resection and (2) in 49 patients who underwent resection and lymph node dissection for IHCC. In addition to determining the clinicopathologic factors, the investigators also performed immunohistochemical examination of microvessel counts using antihuman CD-31 and antibody. Results The significant poor prognostic factors in node-negative IHCC were the presence of intrahepatic metastasis, portal vein invasion of cancer cells, and high microvessel counts. After multivariate analysis was conducted, the independent poor prognostic factors were the presence of intrahepatic metastases and high microvessel counts. Of 9 patients who had postoperative recurrence of their disease, intrahepatic recurrence was observed in 7 (78 %). Conclusions The factors linked to poor prognosis in IHCC were tumor angiogenesis and the presence of intrahepatic metastasis. Because intrahepatic recurrence was common, regional and adjuvant chemotherapy to the liver may improve the outcome of patients with these risk factors and node-negative IHCC.

Although significantly higher serum levels of liver transaminases are commonly observed after hepatic resection, the factors responsible for the increase and the association between the increase and the postoperative course remain unclear.The study population comprised 70 patients who had undergone hepatic resection except hepatectomy with vascular and biliary reconstruction. The relation between the perioperative factors and postoperative aspartic aminotransferase (AST) and alanine aminotransferase (ALT) elevations were analyzed. Outcome parameters, i.e., postoperative total bilirubin level, hospital stay and complications were also analyzed.The average maximum postoperative serum AST and ALT levels were 444.6 IU/L and 390.1 U/L. None of the preoperative factors examined, such as AST, ALT, associated liver disease, Liver Damage Classification, intraoperative hypotension, intraoperative blood loss or types of liver resection, were significantly correlated with liver enzyme elevations. The only factor that was significantly correlated was frequency of intermittent inflow occlusion (p0.001). The elevations of AST and ALT were not significantly correlated with length of hospital stay and postoperative serum bilirubin level. ALT also was not correlated to complications, whereas AST was significantly correlated to the frequency of the postoperative complications.The frequency of intermittent inflow occlusion is the only factor that affects the postoperative enzyme elevation.

A 65-year-old man who presented with adrenal insufficiency was admitted on Feburuary 9, 1988. CT scan showed bilateral swelling of adrenals; open biopsy of the tumor revealed non-Hodgkin's lymphoma. The serum level of catecholamines and calcitonin was elevated. A combination chemotherapy was started. After 3 courses of the treatment remission was achieved, following recovery from adrenal insufficiency. In November, 1988, he had pulmonary infiltration and high fever, resolved by the administration of antibiotics and antifungal drugs. On January 27, 1989, he underwent emergency operation because of perforation of gastric ulcer. In Feburuary, tumor increased in size, and the disease became progressive. On April 2, 1989, he died of respiratory failure. Autopsy revealed a definite diagnosis of malignant lymphoma, diffuse large cell type. Immunohistological studies revealed B cell origin of the cells based on positive LCA and pan B markers.