title: An icteric type hepatocellular carcinoma with no detectable tumor in the liver: report of a case.
abstract: A 70-year-old man was admitted to our hospital with obstructive jaundice. Computed tomography revealed a tumor in the left intrahepatic bile duct extending to the common bile duct without any significant lesions in the liver. Cholangiography showed a filling defect due to an intraductal tumor. Cytology of the bile juice was negative and tumor markers were carcinoembryonic antigen 5.7 ng/ml, carbohydrate antigen 19-9 49 U/ml, alpha-fetoprotein 9 ng/dl, and PIVKA-II 19 200 AU/ml. With a preoperative diagnosis of hilar bile duct carcinoma, a laparotomy was performed. The common bile duct was filled with a tumor and it extended into the bilateral intrahepatic bile ducts. The intraductal tumor was removed together with the extrahepatic bile ducts. An intraoperative histological examination of the tumor showed a well-differentiated hepatocellular carcinoma. No lesions were detected in the liver by ultrasonography, palpation during the operation, or a computed tomography scan after the operation. At 1 year postoperatively, no recurrence has been seen in this patient.
authors.affiliation: Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Osaka, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Makino
authors.forename: Shoji
authors.initials: S
authors.lastname: Nakamori
authors.forename: Masaki
authors.initials: M
authors.lastname: Kashiwazaki
authors.forename: Norikazu
authors.initials: N
authors.lastname: Masuda
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ikenaga
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hirao
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Fujitani
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Mishima
authors.forename: Toshiro
authors.initials: T
authors.lastname: Sawamura
authors.forename: Masashi
authors.initials: M
authors.lastname: Takeda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Mano
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Tsujinaka
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology* / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology*; D008297:Male