Abstract
Two patients with hepatocellular carcinoma (HCC) growing into the extrahepatic bile duct are presented. One patient showed a clinical picture of obstructive jaundice because of clot formation in the common bile duct. The tumor was successfully removed by hepatic lobectomy with resection of the extrahepatic bile duct in each patient. One patient died three months after surgery, developing rapid tumor recurrence in the residual liver, whereas the other patient survived for seven years, despite pulmonary metastasis and rupture of esophageal varices which were managed surgically. Such long-term survival after resection of HCC growing into the bile duct is extremely rare. The patient ultimately died of hemorrhagic pneumonia without any evidence of recurrent tumor at autopsy. The doubling time of alpha-fetoprotein (T2AFP) and a DNA histogram of the tumor cells were studied. The first patient showed a short T2AFP of 27 days and an aneuploid pattern in the DNA histogram. On the other hand, the second showed a long T2AFP of 216 days and a tetraploid pattern in the DNA histogram. Thus, there were differences in T2AFP and the DNA histograms of the tumor cells between the two patients, which suggests there might be a difference in tumor character.
