Kojiro M, Kawabata K, Kawano Y, Shirai F, Takemoto N, Nakashima T
Cancer. 1982 May 15;49(10):2144-7. doi: 10.1002/1097-0142(19820515)49:10<2144::aid-cncr2820491026>3.0.co;2-o.
We describe the features of 24 cases of hepatocellular carcinoma (HCC) with prominent intrabile duct tumor growth seen among 238 autopsy and 21 surgical cases of HCC. Progressive obstructive jaundice occurred during the course of most cases and was the presenting sign in nine. A fluctuating rise and fall of the total bilirubin was seen in two cases. The average survival time of the cases was significantly shorter than that of HCC patients without intrabile duct tumor growth (Mann-Whitney's U-test, one-tailed, P less than 0.05). The average survival time after the development of severe jaundice (total bilirubin over 10 mg/dl) was only 16 days. Intrabile duct tumor casts were located in the hepatic and/or the common bile ducts in 19 cases (79%) and in five cases were seen in the peripheral (medium to small-sized) bile ducts. Hemobilia developed in five cases (21%) and was regarded as the immediate cause of death in one. Grossly all the cases presented infiltrative or mixed (infiltrative and nodular) growth pattern. Intrabile duct tumor growth and associated marked obstructive jaundice may frequently herald the terminal phase of HCC in certain patients. In our series, approximately 40% of patients with HCC and significant jaundice had gross evidence of extensive intraductal tumor growth. In the absence of intraductal tumor growth, jaundice in HCC usually was seen in a setting of progressive terminal hepatic failure.
我们描述了在238例尸检和21例手术的肝细胞癌（HCC）病例中，24例出现显著肝内胆管肿瘤生长的肝细胞癌的特征。大多数病例在病程中出现进行性梗阻性黄疸，9例以此为首发症状。2例出现总胆红素的波动升降。这些病例的平均生存时间显著短于无肝内胆管肿瘤生长的HCC患者（Mann-Whitney U检验，单尾，P<0.05）。出现严重黄疸（总胆红素超过10mg/dl）后的平均生存时间仅为16天。19例（79%）肝内胆管肿瘤栓子位于肝内和/或胆总管，5例见于外周（中至小）胆管。5例（21%）发生胆道出血，1例被视为直接死因。大体上，所有病例均呈现浸润性或混合性（浸润性和结节性）生长模式。肝内胆管肿瘤生长及相关的明显梗阻性黄疸可能经常预示某些HCC患者的终末期。在我们的系列研究中，约40%有显著黄疸的HCC患者有广泛导管内肿瘤生长的大体证据。在无导管内肿瘤生长的情况下，HCC中的黄疸通常见于进行性终末期肝衰竭的背景下。
