title: Extrahepatic intraductal ectopic hepatocellular carcinoma: bile duct filling defect.
abstract: BACKGROUND
  Obstructive jaundice caused by an intraductal hepatocellular carcinoma is a rare initial symptom. We report a rare case of an extrahepatic icteric type hepatocellular carcinoma.
  
  
  METHODS
  A 75-year-old patient was admitted to our hospital because of obstructive jaundice 3 months after resection of multilocular hepatocellular carcinoma. A postoperative bile leakage was treated by placement of a decompressing stent in the common bile duct. Endoscopic retrograde choledochoscopy showed extended blood clots filling the bile duct system and computed tomography revealed a local swelling in the common extrahepatic bile duct. The level of alpha-fetoprotein (AFP) was only slightly elevated but that of CA19-9 was dramatically increased. Cholangiography showed an intraductal filling defect typical of a cholangiocellular carcinoma.
  
  
  RESULTS
  Bile duct brushing cytology showed no cholangiocellular carcinoma but hepatocellular carcinoma cells in the extrahepatic bile duct. An extrahepatic bile duct resection was performed. Histological examination confirmed the diagnosis of extrahepatic intraductal growth of hepatocellular carcinoma.
  
  
  CONCLUSIONS
  Ectopic hepatocellular carcinoma is a rare but important differentially diagnosed of extrahepatic bile duct filling defect.
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich-Heine-University Dusseldorf, Germany. moritz.schmelzle@med.uni-duesseldorf.de
authors.forename: Moritz
authors.initials: M
authors.lastname: Schmelzle
authors.forename: Hanno
authors.initials: H
authors.lastname: Matthaei
authors.forename: Nadja
authors.initials: N
authors.lastname: Lehwald
authors.forename: Andreas
authors.initials: A
authors.lastname: Raffel
authors.forename: Roy Y
authors.initials: RY
authors.lastname: Tustas
authors.forename: Natalia
authors.initials: N
authors.lastname: Pomjanski
authors.forename: Petra
authors.initials: P
authors.lastname: Reinecke
authors.forename: Marcus
authors.initials: M
authors.lastname: Schmitt
authors.forename: Jan
authors.initials: J
authors.lastname: Schulte Am Esch
authors.forename: Wolfram T
authors.initials: WT
authors.lastname: Knoefel
authors.forename: Claus F
authors.initials: CF
authors.lastname: Eisenberger
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D018395:CA-19-9 Antigen / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D041781:Jaundice, Obstructive / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: C097353:AFP protein, human; D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D000509:alpha-Fetoproteins