Repeated Recurrence in the Extrahepatic Bile Duct after Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombosis: A Case Report

Hiroyuki Kanazawa, Iwao Ikai, Fumitaka Oike, Seisuke Sakamoto, Etsuro Hatano, Shinji Uemoto and Fumi Kawakami*

Department of Surgery, Graduate School of Medicine, Kyoto University
Department of Diagnostic Pathology, Kyoto University Hospital*

We report a case of hepatocellular carcinoma (HCC) with bile duct tumor thrombosis (BDTT) followed by two times recurrences of solitary tumors in the extrahepatic bile duct after hepatectomy. A 72-year-old man who underwent right hepatectomy and bile duct thrombectomy for HCC with BDTT suffered jaundice. Jaundice was appeared at eight months after surgery. ERCP showed a filling defect in the common hepatic duct. The solitary recurrent lesion was resected together with a part of the bile duct wall. At seven months after second laparotomy, a solitary tumor recurred in a lower bile duct distant from the first recurrent site. He underwent resection of the extrahepatic bile duct including recurrent tumor and hepaticojejunostomy. Pathologically, the recurrent tumor invaded the bile duct epithelium. We assumed that tumor cells floating in the bile juice were implanted on extrahepatic bile duct epithelium. The patient was well without recurrence at sixteen months after the last surgery.

Key words
hepatocellular carcinoma, bile duct tumor thrombosis, thrombectomy

Reprint requests
Hiroyuki Kanazawa Department of Surgery, Graduate School of Medicine, Kyoto University
54 Shogoin kawara-cho, Sakyo-ku, Kyoto, 606-8507 JAPAN

Accepted
January 28, 2009

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