title: Hepatocellular carcinoma presenting with obstructive jaundice: a clinicopathological study of eight cases.
abstract: OBJECTIVE
  The prognosis of icteric type hepatocellular carcinoma is extremely poor, not only because of obstructive jaundice, but also because of difficulties for early diagnosis. The aim of this study is to evaluate characteristics of icteric hepatocellular carcinoma for early diagnosis.
  
  
  METHODS
  Eight patients with icteric hepatocellular carcinoma among 326 patients with hepatocellular carcinoma in our hospitals were retrospectively examined by laboratory data, image studies and pathology studies.
  
  
  RESULTS
  Most cases were already advanced, with a portal tumor thrombus at the time of diagnosis. Imaging studies fail to reveal tumors because this type of hepatocellular carcinoma has an irregular faint margin and has lost the characteristic pattern of hepatocellular carcinoma, such as capsular formation or early enhancement. Pathology observations demonstrated poorly or moderately differentiated hepatocellular carcinoma in all our cases.
  
  
  CONCLUSIONS
  This type of hepatocellular carcinoma should be considered in cirrhotic patients with obstructive jaundice or in patients with high tumor marker levels even if image studies fail to reveal tumors. For better prognosis, combination therapies such as biliary drainage, support for portal flow as well as treatment for the hepatocellular carcinoma, are necessary.
authors.affiliation: First Department of Internal Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Kazumoto
authors.initials: K
authors.lastname: Murata
authors.forename: Katsuya
authors.initials: K
authors.lastname: Shiraki
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kawakita
authors.forename: Norihiko
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okano
authors.forename: Takahisa
authors.initials: T
authors.lastname: Sakai
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ohmori
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Deguchi
authors.forename: Atsuya
authors.initials: A
authors.lastname: Shimizu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakano
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D002423:Cause of Death; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D006801:Humans; D007564:Japan; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D017093:Liver Failure / Q000401:mortality; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011169:Portal Vein / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor