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| Extrahepatic intraductal ectopic hepatocellular carcinoma: bile duct filling defect |
| Moritz Schmelzle, Hanno Matthaei, Nadja Lehwald, Andreas Raffel, Roy Y. Tustas, Natalia Pomjanski, Petra Reinecke, Marcus Schmitt, Jan Schulte am Esch, Wolfram T. Knoefel and Claus F. Eisenberger |
Düsseldorf, Germany
Author Affiliations: Department of General, Visceral and Pediatric Surgery (Schmelzle M, Matthaei H, Lehwald N, Raffel A, Tustas RY, Schulte am Esch J, Knoefel WT and Eisenberger CF), Institute of Cytopathology (Pomjanski N), Institute of Pathology (Reinecke P), and Department of Gastroenterology, Hepatology and Infectious Diseases (Schmitt M), Heinrich-Heine-University Düsseldorf, Germany
Corresponding Author: Moritz Schmelzle, MD, Department of General Surgery, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany (Tel: 0049 (0)211 81 17376; Fax: 0049 (0)211 81 17352; Email: moritz.schmelzle@med.uni-duesseldorf.de) |
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Abstract 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.
CONCLUSION: Ectopic hepatocellular carcinoma is a rare but important differentially diagnosed of extrahepatic bile duct filling defect.
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2009, Vol. 8 
