Extrahepatic intraductal ectopic hepatocellular carcinoma: bile duct filling defect.
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.
Schmelzle
Moritz
M
Department of General, Visceral and Pediatric Surgery, Heinrich-Heine-University Dusseldorf, Germany. moritz.schmelzle@med.uni-duesseldorf.de
Matthaei
Hanno
H
Lehwald
Nadja
N
Raffel
Andreas
A
Tustas
Roy Y
RY
Pomjanski
Natalia
N
Reinecke
Petra
P
Schmitt
Marcus
M
Schulte Am Esch
Jan
J
Knoefel
Wolfram T
WT
Eisenberger
Claus F
CF
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
C097353:AFP protein, human; D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D000509:alpha-Fetoproteins