Extraction of intra-biliary hepatocellular carcinoma by endoscopic retrograde cholangiopancreatography
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CASE REPORT
Extraction of intra-biliary hepatocellular carcinoma by endoscopic retrograde cholangiopancreatography Chieh Sian Koo1, Khek Yu Ho1,2, Yin Huei Pang3 and Daniel Q. Huang1,2*
Abstract Background: Hepatocellular carcinoma with biliary ductal invasion is rare and associated with a significantly lower survival rate. Case presentation: We present an unusual case of a patient with hepatocellular carcinoma and biliary invasion, who had his diagnosis confirmed by histological analysis from tissue extracted by endoscopic retrograde cholangiopancreatography. An 87-year-old male presented with a 1-day history of right upper quadrant pain and jaundice. His past medical history included recurrent gallstone cholangitis and a previous cholecystectomy. An abdominal CT demonstrated a dilated intrahepatic biliary tree with left proximal intrahepatic hyperdensities, as well as a 3 cm hepatocellular carcinoma. He was initially suspected to have concurrent gallstone cholangitis and a newly diagnosed hepatocellular carcinoma. Endoscopic retrograde cholangiopancreatography and balloon trawling of the intraductal lesions extracted necrotic tumour-like tissue which was histologically consistent with hepatocellular carcinoma. The extraction of the intra-biliary portion of HCC resulted in complete resolution of his jaundice, enabling further treatment with nivolumab, which would not have been possible if the obstruction was not cleared. The patient is currently well and has completed his 6th cycle of nivolumab. Conclusion: Obstructive jaundice is an uncommon presentation for patients with HCC. it is key for clinicians to be aware of the possibility of intrabiliary invasion in order obtain an early diagnosis and to reduce any delay in treatment. Keywords: Intrabiliary, Intraductal, Hepatocellular carcinoma, Endoscopic retrograde cholangiopancreatography, Case report Background Hepatocellular carcinoma (HCC) is the most common primary malignant hepatic neoplasm. However, it only rarely shows biliary ductal invasion, with a reported incidence of 1–9% [1, 2]. We discuss an unusual presentation of a patient with obstructive jaundice secondary to HCC with intrabiliary invasion, who had his diagnosis confirmed from tissue that was retrieved by endoscopic *Correspondence: [email protected] 2 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Full list of author information is available at the end of the article
retrograde cholangiopancreatography (ERCP). These patients typically have a poor prognosis. Therefore, it is key for clinicians to be aware of this entity in order obtain an early diagnosis and to reduce any delay in treatment.
Case presentation An 87-year-old Chinese male presented with right upper quadrant pain and obstructive jaundice for one day. He had no fever, nausea, or vomiting. He had no history of alcohol use. His medical history was significant for hyperlipidemia, diabetes mellitus, recurrent gallstone cholangitis, and a previous c
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