Sloughing of biliary tumour ingrowth of hepatocellular carcinoma after chemoembolization.
OBJECTIVE
To describe the imaging findings and clinical course of sloughing of biliary tumour ingrowth of hepatocellular carcinoma (HCC) after chemoembolization.


METHODS
We reviewed 12 patients who experienced sloughing of biliary tumour ingrowth after chemoembolization. We evaluated the patients' characteristics, clinical manifestations and treatment modalities. We also reviewed computed tomography (CT) scans to determine the characteristics of the sloughed tumour including length, attenuation and appearances during follow-up.


RESULTS
The length of the sloughed tumour ranged from 0.6-7.8 cm. Their Hounsfield units ranged from 35-729. Sloughed tumours were misreported as biliary stones in four patients, and were not reported in the initial CT report in one patient. At the time of sloughing, seven patients complained of cholestatic symptoms, while the other five had no symptoms. Four patients underwent sphincterotomy and tumour removal under endoscopic retrograde cholangiopancreaticography (ERCP), two underwent percutaneous transhepatic biliary drainage (PTBD) and one underwent PTBD followed by ERCP. The remaining five were managed conservatively. Five sloughed tumours were removed by ERCP, six disappeared spontaneously within 3 months, and one patient had no follow-up image.


CONCLUSIONS
Sloughing of biliary tumour ingrowth may be misinterpreted as biliary stone, and may or may not cause cholestatic symptoms.


CONCLUSIONS
• Migration of intraductal tumour ingrowth of HCC after chemoembolization occurs more commonly than reported. • The sloughed tumour is often misinterpreted as biliary calculi. • It can make cholestasis and be managed by ERCP or PTBD. • In some asymptomatic cases, a wait-and-see approach can be taken.
Department of Radiology, Research Institute Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Gyoung Min
GM
Kim
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea. angiointervention@gmail.com.
Hyo-Cheol
HC
Kim
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
Saebeom
S
Hur
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
Myungsu
M
Lee
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
Hwan Jun
HJ
Jae
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
Jin Wook
JW
Chung
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002779:Cholestasis / Q000175:diagnosis; D003951:Diagnostic Errors; D004322:Drainage / Q000379:methods; D004621:Embolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects
Chemoembolization; Endoscopic retrograde cholangiopancreaticography; Hepatocellular carcinoma; Intraductal tumour ingrowth; Percutaneous transhepatic biliary drainage