3 Successfully Resected Cases of Hepatocellular Carcinoma with bile duct thrombi

Hiroo Takayama, Noriyuki Oba, Toshiyuki Ori, Masakazu Takagi, Kazuhiko Nakagami, Joji Iseki, Kazushige Toyama, Kazuki Ito¹⁾ and Hiroyuki Muro²⁾

Department of Surgery, Shizuoka General Hospital Department of Gastroenterology, Shizuoka General Hospital¹⁾ Department of Pathology, Shizuoka General Hospital²⁾

Three (6.6%) of 45 patients with hepatocellular carcinoma (HCC) treated surgically at our institution between 1995 and 1999, had bile duct thrombi. On initial examination, the chief clinical presentation of these three patients was not jaundice, but did have abdominal pain or fever. CT scanning and ultrasonography revealed the presence of liver tumors, and cholangiography revealed the bile duct thrombi. Biliary drainage was performed preoperatively to control the cholangitis. Successful hepatectomy was performed in all the cases. Histopathologically, these tumors were diagnosed as HCC with invasion in the bile duct. HCC with bile duct thrombi has been termed "icteric-type hepatoma", which is associated with a high frequency of obstructive jaundice and a low survival rate. In our series, however, none of the patients showed clinical jaundice. Advances in radiological diagnostic techniques probably enabled us to detect and treat these patients at an earlier stage, before obstructive jaundice could develop.

Key words
icteric-type hepatoma, obstructive jaundice, hepatectomy

Reprint requests
Noriyuki Oba Department of Surgery, Shizuoka General Hospital 4-27-1 Kita-ando,Shizuoka,420-0881 JAPAN

Accepted
September 20, 2000

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