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KMID : 0360919700130070589
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Journal of the Korean Medical Association
1970 Volume.13 No. 7 p.589 ~ p.593
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A CASE OF OBSTRUCTIVE JAUNDICE COMPLICATION HEPATOMA
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南宮陞/Nam, Kook Seung
徐正燉/李昌弘/李容國/李原魯/Seo, Jung Don/Lee, Chang hong/Rhee, Yong Kuk/Lee, Won Ro
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Abstract
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Authors report a rare complication of hepatoma, obstructive Jaundice.
The obstructive jaundice in hepatoma^(6-13) is very rare. There are at least three mechanisms through which extrahepatic biliary obstruction occurs in hepatoma:
1. Metastasis and intraductal growth of the tumor in the biliary buct.
2. Embolism of necrotic tumor debris and/or blood clots in the biliary duct.
3. Enlarged liver compressing extraductally the biduct.
A 51-year-old man entered Seoul National University Hospital with the chief complaints of severe jaundice and itching of 2 weeks´ duration. Another positive finding was the mild enlargement of left lobe of the liver, firm and nontender on palpation. Stool was claywhite in color and contained Clonorchis sinensis ova. Urinalysis showed bilirubinuria and trace amount of urobilinogen. Biochemical liver function tests revealed marked elevation of serum bilirubin level and slight elevation of alkaline phosphatase and transaminase activities. Liver scan using colloidal^(198)-Au showed no cold area and gallbladder study with ^(131)I-Rose bengal suggested definite obstruction in the distal part of the ,common bile duct. During 2 months´ preoperative period there were 2 episodes of jaundice, the first cleared spontaneously and the second postoperatively. Operative finding was impaction of amorphous necrotic -tissue with blood clots in the common bile duct at the portion of bifurcation of the cystic duct. The liver was cirrhotic but no evidence of presence of any mass in the liver was found on meticulous palpation. Wedgebiopsied liver specimen also showed no evidence of malignancy on microscopy. However, the evacuated tissue from the common bile duct was confirmed to consist of necrotic tissue with cancerous cells(hepatocellular carcinoma), blood clots and C. sinensis ova. The final histological diagnosis was hepatocellular carcinoma, with liver cirrhosis and clonorchiasis.
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KEYWORD
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