Department of General, Visceral and Pediatric Surgery, Heinrich-Heine-University Dusseldorf, Germany.
Hepatobiliary Pancreat Dis Int. 2009 Dec;8(6):650-2.
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.
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.
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.
Ectopic hepatocellular carcinoma is a rare but important differentially diagnosed of extrahepatic bile duct filling defect.
由胆管内肝细胞癌引起的阻塞性黄疸是一种罕见的首发症状。我们报告一例罕见的肝外黄疸型肝细胞癌。
一名 75 岁男性患者在多房性肝细胞癌切除术后 3 个月因阻塞性黄疸入院。术后胆漏采用胆总管减压支架治疗。内镜逆行胰胆管造影显示胆管系统内广泛延伸的血凝块，计算机断层扫描显示肝外胆总管局部肿胀。甲胎蛋白（AFP）水平仅略有升高，但 CA19-9 显著升高。胆管造影显示典型的胆管细胞癌胆管内充盈缺损。
胆管刷检细胞学检查未见胆管细胞癌，但在外周胆管中可见肝细胞癌细胞。行肝外胆管切除术。组织学检查证实了肝外胆管内生长的肝细胞癌的诊断。
异位肝细胞癌是一种罕见但重要的需要鉴别的肝外胆管充盈缺损的疾病。
