Caution for Diagnosis and Surgical Treatment of Recurrent Cholangitis

Abstract

The hepatocellular carcinoma (HCC) patients with bile duct tumor thrombus (BDTT) usually have no specific clinical symptoms at early stages. HCC with BDTT was usually misdiagnosed when the intrahepatic tumor was small, even undetectable.In this study, 5 cases of HCC with BDTT misdiagnosed as choledocholithiasis and cholangitis in the local hospital are described. We analyzed retrospectively and summarized our experiences of these 5 HCC patients with BDTT misdiagnosed in the local hospital during the past 5 years. The diagnosis, treatment, and outcome of the patients are discussed.Three patients underwent hepatectomy with thrombectomy and T-tube drainage. One patient underwent hepatectomy with the resection of the common bile duct and hepatojejunostomy, and palliative surgery was performed in 1 patient with portal vein tumor thrombus and intrahepatic metastasis. The patients were followed for 6–22 months; 4 patients died of tumor recurrence and metastasis or hepatic failure, despite 3 of these patients having received transhepatic arterial chemotherapy and embolization or radiofrequency ablation therapy.Early and accurate diagnosis of HCC with BDTT is very important. When patients have a history of abnormal recurrent cholangitis, HCC with BDTT should be highly suspected. Intraductal ultrasonography (US), intraoperative US, and histopathological examination are very valuable for the diagnosis. The prognosis of HCC patients with BDTT is dismal. Identification of this type of patient is clinically important, because surgical treatment may be beneficial.

<p>The Prognostic Comparison Between Hepatocellular Carcinoma with Portal Vein Tumor Thrombus and Bile Duct Cancer Thrombus After Liver Resection</p>

“…31 Currently, it is believed that the occurrence of liver cancer combined with BDTT is related to the biological characteristics of the tumor, the body's microenvironment, the human immune status, the adjacent relationship between liver cancer and bile ducts, but not to the size of liver cancer. 32,33 Tumor cells first invade the sub-epithelium of the adjacent small bile duct, and then they grow continuously along the bile duct wall to the extrahepatic bile duct. 32,33 The presence of BDTT usually implies a poor prognosis.…”

“…32,33 Tumor cells first invade the sub-epithelium of the adjacent small bile duct, and then they grow continuously along the bile duct wall to the extrahepatic bile duct. 32,33 The presence of BDTT usually implies a poor prognosis. Due to the misunderstandings of HCC with BDTT that these patients are already in an advanced stage, some patients fail to receive more effective treatment.…”

Radiofrequency Ablation of the Main Lesion of Hepatocellular Carcinoma and Bile Duct Tumor Thrombus as a Radical Therapeutic Alternative

“… 2 – 8 The size of primary HCC is not correlated with the occurrence of BDTT, and BDTT may exist in patients with primary HCC (≤3.0 cm) as well as in those without detectable primary HCC. 13 – 15 …”

The Structural Bile Ducts Organization in the Pathological Conditions

“…Все частіше у фаховій літературі трапляються повідомлення про злоякісні новоутворення жовчних проток [72,73,74,75,76,77,78,79,80]. Пошкодження епітелію жовчних проток і обструкція потоку жовчі збільшує трансформацію холангіоцитів, що, в свою чергу, може лежати в основі патогенезу холангіокарциноми [81,82,83,84].…”