A Resected Case of Hepatocellar Carcinoma with Hemobilia from Intrabile Duct Tumor Thrombus

Abstract

A 75-year-old man with hepatocellular carcinoma repeatedly undergoing TAE and PEIT war referred for tumor recurrence. He underwent TAE once more, but the tumor did not decrease in size, and he was readmitted. On the day of admission, he reported tarry stool followed by upper abdominal pain and nausea upon evacuation. His hemoglobin decreased to 8.3 g/dl. Ultrasonography and CT showed an intrabile duct tumor thrombus at the lateral segment of the liver and dilatation of the peripheral bile duct. Angiography showed a slight tumor stain at the lateral segment of the liver. Percutaneous transhepatic cholangiography did not show the left bile duct, but showed filling defects in the common bile duct. Based on a diagnosis of hepatocellular carcinoma with hemobilia from an intrabile duct tumor thrombus. We conducted left hepatic lobectomy and incision of the common bile duct with removal of coagula. Pathology revealed poorly differentiated hepatocellular carcinoma with sarcomatous changes.