title: Acute obstructive cholangitis complicated by tumor migration after transarterial chemoembolization: a case report and literature review.
abstract: Intraductal tumor invasion of hepatocellular carcinoma (HCC) is considered rare. Transarterial chemoembolization (TACE) is effective for tumor thrombus of HCC in the bile duct. However, a few cases of obstructive jaundice caused by migration of a tumor fragment after TACE have recently been reported. The aim of this study was to identify factors that affect tumor migration after TACE. At this writing, a review of the medical literature disclosed seven reported cases of biliary obstruction caused by migration of a necrotic tumor cast after TACE. We, herein, report on an additional case of acute obstructive cholangitis complicated by migration of a necrotic tumor cast after TACE for intrabile duct invasion of HCC, in a 71-year-old man. The tumor cast in the common bile duct was removed successfully using a basket during ERCP and was pathologically confirmed to be a completely necrotic fragment of HCC. The patient's symptoms showed dramatic improvement. In summary, physicians should be aware of acute obstructive cholangitis complicated by tumor migration in a patient undergoing TACE. We suggest that an intrabile duct invasion would be a major predisposing factor of tumor migration after TACE and drainage procedures such as ERCP or percutaneous transbiliary drainage could be effective treatment modalities in these patients.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 501-746, Korea.
authors.forename: Hyung Chul
authors.initials: HC
authors.lastname: Park
authors.forename: Hyun Bum
authors.initials: HB
authors.lastname: Park
authors.forename: Cho Yun
authors.initials: CY
authors.lastname: Chung
authors.forename: Min Woo
authors.initials: MW
authors.lastname: Jung
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Joo
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Choi
authors.forename: Sung Bum
authors.initials: SB
authors.lastname: Cho
mesh_terms: D000208:Acute Disease; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002761:Cholangitis / Q000209:etiology*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D008297:Male; D009336:Necrosis / Q000473:pathology; D016717:Sphincterotomy, Endoscopic; D013927:Thrombosis / Q000209:etiology; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents