부산대학교 도서관

An 84-year-old man underwent plain computed tomography (CT) on developing pneumonia and was referred to our department because a mass in the caudate lobe of the liver was incidentally identified. Blood tests showed tumor marker elevations, with alpha-fetoprotein (AFP) 1,636.3 ng/ml and protein induced by vitamin K absence or antagonist-II (PIVKA-II) 1,927.0 mAU/ml. Contrast-enhanced CT showed a mass measuring approximately 4 cm × 4 cm in the caudate lobe, which was stained during the early phase of contrast and washed out in the late phase. Hepatocellular carcinoma was suspected. The images also showed that the main trunk of the portal vein bifurcated into two branches at the hepatic portal, from which the vein flow reached into the anterior and posterior segments of the right lobe, while the left portal vein was missing. Portal vein flow of the left hepatic lobe was provided by a network of vessels that reached the left lobe from the periphery of the anterior segment branch of the portal vein via the hepatic parenchyma. Premovist contrast-enhanced magnetic resonance imagin (MRI) did not show any other lesions. Single hepatocellular carcinoma in the caudate lobe was diagnosed from these findings, and total caudate lobectomy was performed. The patient's postoperative course was good, and the patient was discharged without complications on postoperative Day 9. We report this rare case of total caudate lobectomy associated with absence of portal bifurcation, together with a short discussion of the literature.