Hepatocellular carcinoma presenting as intrabile duct tumor growth. A clinicopathologic study of 24 cases

Abstract

We describe the features of 24 cases of hepatocellular carcinoma (HCC) with prominent intrabile duct tumor growth seen among 238 autopsy and 21 surgical cases of HCC. Progressive obstructive jaundice occurred during the course of most cases and was the presenting sign in nine. A fluctuating rise and fall of the total bilirubin was seen in two cases. The average survival time of the cases was significantly shorter than that of HCC patients without intrabile duct tumor growth (Mann-Whitney's U-test, one-tailed, P less than 0.05). The average survival time after the development of severe jaundice (total bilirubin over 10 mg/dl) was only 16 days. Intrabile duct tumor casts were located in the hepatic and/or the common bile ducts in 19 cases (79%) and in five cases were seen in the peripheral (medium to small-sized) bile ducts. Hemobilia developed in five cases (21%) and was regarded as the immediate cause of death in one. Grossly all the cases presented infiltrative or mixed (infiltrative and nodular) growth pattern. Intrabile duct tumor growth and associated marked obstructive jaundice may frequently herald the terminal phase of HCC in certain patients. In our series, approximately 40% of patients with HCC and significant jaundice had gross evidence of extensive intraductal tumor growth. In the absence of intraductal tumor growth, jaundice in HCC usually was seen in a setting of progressive terminal hepatic failure.

Surgical treatment of hepatocellular carcinoma with bile duct tumor thrombi

“…[6] , clinically classified such cases as "icteric type hepatoma", which manifested as obstructive jaundice even at the early stage of tumors, and pointed out that its differential diagnosis was very difficult. In 1982, Kojiro et al [7] , first described the clinical and pathological features of HCC invading the bile duct, and clarified that it was not equal to the portal vein thrombi (PVT), indicating the possibility of extensive dissemination in terms of severity of the disease. They considered that it was not necessarily a criterion of advanced disease.…”

Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus, Including Cases with Obstructive Jaundice

“…In particular, HCC with BDTT showing obstructive jaundice is called icteric hepatoma, and this type of HCC is known to present difficult problems in the differential diagnosis of conditions such as advanced liver cirrhosis and biliary tract cancer. 2 HCC with BDTT showing obstructive jaundice leads to severe symptoms such as cholangitis and hemobilia, and can cause hepatic failure. [3][4][5] However, it is difficult to determine the surgical indications for patients with obstructive jaundice because jaundice due to advanced liver cirrhosis is a contraindication for hepatectomy.…”

Intraductal migration of necrotic hepatocellular carcinoma: A possible cause of obstructive cholangitis after chemoembolization

“…4 Due to the ischemic effects of Lipiodol and gelfoam particles, tumors become necrotic and the intraductal tumor portion can detach from the main tumor and migrate into the duct. Because the ductal epithelium underlying the intraductal tumor ingrowth is usually preserved and the intraductal tumor does not attach tightly to the duct, 13 intraductal tumors that become necrotic after chemoembolization can easily detach from the main tumor and migrate into the bile duct. 10 CT scans can show a new soft tissue lesion with or without a radiodense portion, which suggests a migrated tumor with retained Lipiodol in the distal CBD.…”