A Case Report of Solitary Metastatic Hepatocellular Carcinoma in the Common Bile Duct

• Published in: Nippon Shokaki Geka Gakkai zasshi Vol. 31; no. 11; pp. 2245 - 2249
• Main Authors: Yokoyama, Tadashi, Yo, Mintetsu, Kumano, Kimitsuka, Ichinose, Masumi, Kondo, Motohiro, Henmi, Kimio, Yoshida, Keisuke, Takahara, Hidenori, Jikko, Akira
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 1998
• Subjects: implant; metastatic hepatocellular carcinoma; obstructive jaundice
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.31.2245

A 59-year-old woman was admitted complaining of jaundice. She had undedrgone left lobectomy of the liver because of hepatocellular carcinoma fifteen months before. Laboratory examination showed elevation of serum bilirubin and α-fetoprotein levels. Ultrasonography and CT scan revealed a tumor in the common bile duct, about 2cm in diameter, protruding into the markedly dilated common bile duct.T o reduce jaundice, choledochotomy was done, resulting in the removal of a large portion of brown and soft choledochal tumor. This was identified as metastatic hepatoecellular carcinoma histologically, b ecause it was microscopically similar to previously resected hepatoma. Postoperative cholangiography revealed that a small part of the tumor remained. About one month later, pancreatoduodenectomy was performed for radical resection of the remnant tumor, which was histologically diagnosed as metastatic hepatocellular carcinoma. No other metastases were found in other parts of the common bile duct or in the head of the pancreas. Serum bilirubin and α-fetoprotein levels normalized, and she was discharged two months after surgery. According to previous reports, obstructive jaundice in patients with hepatoma was caused by direct invasion of the biliary tract or obstruction by degenerated tissues or blood coagula from the tumor. In the present case, however, choledocal obstruction was caused by metastatic tumor apart from the original tumor. This type of recurrence of hepatoma has been considered to be very rare.I t can be speculated that hepatoma cells separated from the original tumor, floated in bile and werei mplanted on mucosa of the common bile duct.