Hepatocellular Carcinoma with Intrabileduct growing Presenting a Stone-like Radiologic Findings: A Case Report
We report a case of hepatocellular carcinoma with intrabileduct growth, presenting atypical imaging similar to cholelithiasis. A 57-year old man with chronic hepatitis C was admitted for right hypochondralgia and jaundice. Endoscopic retrograde cholangiography (ERC) showed a filling defect in the left hepatic duct. No space-occupying lesion (SOL) of the liver was seen in radiological examination, and he was diagnosed with hepatolithiasis. Symptoms disappeared after conservative treatment and he was discharged. Serum alphafeto-protein (AFP) gradually elevated, however, and he was readmitted for further examination. Radiological examination showed an intrabileduct tumor from the hepatic umbolical portion to the common bile duct (CBD) without SOL of the liver. ERC showed filling defect floating in the CBD. The diagnosis of hepatocellular carcinoma with intrabileduct growth was made and a hepatic left lobectomy conducted. The medial segment of the resected specimen showed a tumor 15mm in diameter. Histopathological diagnosis was poorly differentiated hepatocellular carcinoma with bileduct and portal venous invasion. Recurrence occurred about 2 years after surgery. Despite transcathether arterial embolization and percutaneous ethanol injection therapy, he died about 6 years after surgery.