title: Three cases of small hepatocellular carcinoma presenting as obstructive jaundice.
abstract: BACKGROUND
  Despite improved diagnostic tools, it is often difficult to make a correct diagnosis of small hepatocellular carcinoma (HCC) in patients with obstructive jaundice.
  
  
  METHODS
  Three cases of small HCC (<2 cm diameter) presenting as obstructive jaundice are reported. All tumours were initially diagnosed as hilar cholangiocarcinoma based on ultrasonography, computed tomography, cholangiography and angiography. Because of insufficient hepatic function, none of the patients underwent hepatic resection. One patient died 8 months after first admission to our hospital, another died of disseminated intravascular coagulation I month after admission, and the third was treated with hepatic arterial infusion chemotherapy and survived >36 months.
  
  
  CONCLUSIONS
  It is important to consider HCC in the diagnosis of obstructive jaundice in patients who are predisposed to HCC because of liver cirrhosis and/or chronic viral hepatitis, and have elevated serum alpha-fetoprotein.
authors.affiliation: Department of Surgery, Akita University School of Medicine, l-l-l Hondo, Akita, 010-8543 Japan. ise@surgl.med.akita-u.ac.jp
authors.forename: N
authors.initials: N
authors.lastname: Ise
authors.forename: H
authors.initials: H
authors.lastname: Andoh
authors.forename: T
authors.initials: T
authors.lastname: Sato
authors.forename: O
authors.initials: O
authors.lastname: Yasui
authors.forename: T
authors.initials: T
authors.lastname: Kurokawa
authors.forename: H
authors.initials: H
authors.lastname: Kotanagi