title: Diagnosis of icteric-type hepatocellular carcinoma by fine needle aspiration: a case report.
abstract: BACKGROUND
  Bile duct invasion is very rare in patients with hepatocellular carcinoma (HCC). It usually presents difficult problems with the clinical differential diagnosis. Moreover, another difficulty might arise when an obstructive jaundice patient is found to have past history of 2 separate malignancies. Fine needle aspiration (FNA) becomes the method of choice for clarification of the bile duct tumor thrombus.
  
  
  METHODS
  A 72-year-old man presented with progressive obstructive jaundice for 1 month. Past history revealed the occurrence of 2 distinct malignancies during the previous 3 years; they had been resected successfully. Initial imaging studies, including abdominal sonography and computed tomography, were negative for the liver. However, FNA demonstrated clusters of pleomorphic and hyperchromatic cancer cells with an increased nuclear/cytoplasmic ratio proliferating in a vague trabecular pattern with some appearance of sinusoids. Multinucleated giant cells were seen. No bile duct epithelial cells were seen. The diagnosis of the third separate malignancy, moderately differentiated HCC, was made.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of icteric-type HCC diagnosed by FNA although the primary lesion was undetectable on routine, noninvasive examinations. FNA cytology is an accurate and minimally invasive method for early confirmation of biliary HCC thrombi.
authors.affiliation: Department of Internal Medicine, Fooyin University Hospital, Pingtung, Taiwan, ROC. jeefuhuang@yahoo.com.tw
authors.forename: Jee-Fu
authors.initials: JF
authors.lastname: Huang
authors.forename: Shinn-Cherng
authors.initials: SC
authors.lastname: Chen
authors.forename: Liang-Yen
authors.initials: LY
authors.lastname: Wang
authors.forename: Ming-Lung
authors.initials: ML
authors.lastname: Yu
authors.forename: Chia-Yen
authors.initials: CY
authors.lastname: Dai
authors.forename: Wan Long
authors.initials: WL
authors.lastname: Chuang
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Chang
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D001663:Bilirubin / Q000097:blood; D044963:Biopsy, Fine-Needle; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis; D002779:Cholestasis / Q000209:etiology* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D017809:Fatal Outcome; D022781:Hepatocytes / Q000473:pathology; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000503:physiopathology; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D009062:Mouth Neoplasms / Q000175:diagnosis; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging* / Q000473:pathology; D013624:Taiwan; D017211:Treatment Failure; D014463:Ultrasonography; D014516:Ureteral Neoplasms / Q000175:diagnosis
chemical_list: D001663:Bilirubin