Hepatocellular Carcinoma with Distant Double Bile Duct Tumoral Thrombus: a Case Report

Abstract

The authors report a case of a 3 cm hepatocellular carcinoma at the junction of segments VI and VII with double bile duct tumoral thrombi (Types I and III). The type I thrombus was suspected during the pre-operative workup, but the type III bile duct tumoral thrombus (BDTT) was an intra-operative additional finding on cholangiography. The patient underwent a bisegmental posterolateral resection to remove the primary tumour and the first tumoral thrombus located in the posterolateral intrahepatic duct. A choledocotomy was also performed to remove, by balloon catheter, the floating thrombus located in the common bile duct just over the papilla. The authors discuss their diagnostic and therapeutic approach and review the literature.

Hepatocellular Carcinoma (Ordinary Hepatocellular Carcinoma)

“…Kojiro et al 1982;Sastry et al 1996;Yeh et al 2004;Esaki et al 2005;Huang et al 2006;Ikenaga et al 2009;Liu et al 2011a;Yu et al 2011;Paradis 2013b. Mechanisms of obstructive jaundice comprise either the forming of a growing intraluminal tumor tissue plug, tumor tissue fragments admixed with bile and exudate, or intraductal accumulation of blood or coagulated blood masses derived from necrotic and hemorrhagic intraluminal tumor. Parts of intrabiliary tumors can detach and dislocated to more distal parts (Lam et al 2009). This is mainly due to the loose texture of the tumors and their tendency to undergo necrosis.…”

Caution for Diagnosis and Surgical Treatment of Recurrent Cholangitis

“…Jaundice in HCC patients is divided into hepatocellular and icteric types in terms of its underlying pathophysiology. 6 Hepatocellular-type jaundice in patients with HCC is typically associated with advanced liver cirrhosis or extensive tumor infiltration to liver parenchyma that leads to hepatic insufficiency. 3 , 7 For these patients, life expectancy is short, and aggressive treatment modalities, including surgery, are not recommended.…”