A Case Report of Solitary Metastatic Hepatocellular Carcinoma in the Common Bile Duct

Motohiro Kondo, Akira Jikko, Masumi Ichinose, Mintetsu Yo, Kimitsuka Kumano, Hidenori Takahara, Tadashi Yokoyama, Keisuke Yoshida, Kimio Henmi

Department of Surgery, Ako City Hospital

A 59-year-old woman was admitted complaining of jaundice. She had undedrgone left lobectomy of the liver because of hepatocellular carcinoma fifteen months before. Laboratory examination showed elevation of serum bilirubin and α-fetoprotein levels. Ultrasonography and CT scan revealed a tumor in the common bile duct, about 2 cm in diameter, protruding into the markedly dilated common bile duct. To reduce jaundice, choledochotomy was done, resulting in the removal of a large portion of brown and soft choledochal tumor. This was identified as metastatic hepatoecellular carcinoma histologically, because it was microscopically similar to previously resected hepatoma. Postoperative cholangiography revealed that a small part of the tumor remained. About one month later, pancreatoduodenectomy was performed for radical resection of the remnant tumor, which was histologically diagnosed as metastatic hepatocellular carcinoma. No other metastases were found in other parts of the common bile duct or in the head of the pancreas. Serum bilirubin and α-fetoprotein levels normalized, and she was discharged two months after surgery. According to previous reports, obstructive jaundice in patients with hepatoma was caused by direct invasion of the biliary tract or obstruction by degenerated tissues or blood coagula from the tumor. In the present case, however, choledocal obstruction was caused by metastatic tumor apart from the original tumor. This type of recurrence of hepatoma has been considered to be very rare. It can be speculated that hepatoma cells separated from the original tumor, floated in bile and were implanted on mucosa of the common bile duct.

Key words
metastatic hepatocellular carcinoma, obstructive jaundice, implant

Reprint requests
Motohiro Kondo Department of Surgery, Ako City Hospital
1090 Nakahiro, Ako, 678-0232 JAPAN

Accepted
July 22, 1998

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