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KMID : 0870420040080010050
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2004 Volume.8 No. 1 p.50 ~ p.53
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Hepatocellular Carcinoma Embolus to the Distal Common Bile Duct
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An Ji-Yeong
Choi Seong-Ho
Moon Hyoun-Jong
Heo Jin-Seok
Kim Yong-Il
Chang Weon-Young
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Abstract
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Obstruction of the common bile duct (CBD) by direct extension of a tumor is occasionally found in patients with a hepatic neoplasm, but a bile duct tumor embolus caused by intfabiliary transplantation of a free floating tumor is a rare complication of a hepatocellular carcinoma. A patient of ours was recently observed with a fragment of tumor from a primary hepatocellular carcinoma (HCC) that obstructed the distal CBD. AA6-year-dd man was admitted to our hospital with a distal CBD mass, measuring 1.2 x 1.5 cm, found by a biliary computed tomography (CT) scan. Four month prior to his admission, he had undergone a right hemihepatectomy for a HCC accompanied by direct intrahepatic bile duct invasion, without obstructive jaundice. On admission, there were no abnormal findings in the physical and laboratory examinations. An Endoscopic retrograde cholangiopancreatography and papillotomy had been performed, which showed an irregular shaped filling defect in the distal CBD. Endoscopic nasobiliary drainage (ENBD) was carried out for biliary decompression. Partially extracted soft tissue from the CBD by ERCP revealed a HCC. On performed a pylorus-preserving pancreabooduodenectomy, a 1cm sized tumor remnant was found attached to the mucosa of the intrapanc reatic portion of the bile duct, but without any invasive growth into the submucosa. The tumor may have been an intrabiliary transplantation from the HCC in the right lobe through the bile duct. When an obstructive mass is found in the distal CBD, tumor embolus should be considered, and a radical pancreabcoduodenectomy can be adopted as a safe and effective treatment modality.
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KEYWORD
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Common Bile Duct, Neoplasm Circulating Cells, Carcinoma, Hepatocellular, Pancreaticoduodenectomy
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