A Succesfully Resected Case of Hepatocellular Carcinoma Growing into the Bile Duct with Obstructive Jaundice

Moritsugu Tanaka, Hiromitsu Takeyama, Keiji Mashita, Minoru Yamamoto, Yuuji Okada, Tetsushi Hayakawa, Yoshimi Akamo and Tadao Manabe

First Department of Surgery, Nagoya City University Medical School

A 64-year-old man was admitted for epigastralgia and jaundice. Viral hepatitis markers were negative. He had previously undergone cholecystectomy for cholecystcholedocholithiasisis 1985. Tumor markers increased AFP of 43 ng/ml, CA19-9 of 894 U/ml, DUPAN-2 of 470U/ml and PIVKA-2 of 13. 14AU/ml. Ultrasonography revealed intrahepatic bile duct dilatation and a high echoic mass at the porta hepatis. Percutaneous transhepatic cholangiography showed filling defects in the bilateral hepatic ducts, common hepatic duct and common bile duct. Computed Tomography (CT) scan showed a slightly enhanced mass at S-4 and a partially enhanced mass in the dilatated common bile duct, leading to a diagnosis of hilar cholangiocarcinoma. We conducted left hepatectomy, left caudate lobectomy, and hepaticojejunostomy. Postoperative pathological studies showed that hepatocellular carcinoma (HCC) at S-4 had infiltrated the bile duct. Resection in the case reports of icteric hepatoma are relative rare. It should be emphasized that positive radical resection may make it possible for the patients to obtain a better prognosis.

Key words
icteric hepatoma, obstructive jaundice, hepatectomy

Reprint requests
Moritugu Tanaka First Department of Surgery, Nagoya City University Medical School 1 Kawasumi, Mizuhoku, Nagoya, 467-8601 JAPAN

Accepted
December 12, 2001

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