Caution for diagnosis and surgical treatment of recurrent cholangitis: lessons from 5 cases of bile duct tumor thrombus without a detectable intrahepatic tumor

Hepatocellular carcinoma with tumor thrombus in bile duct: A proposal of new classification according to resectability of primary lesion

BACKGROUND

Hepatocellular carcinoma (HCC) with tumor thrombus in the bile duct (BDTT) is easily misdiagnosed or mistreated due to the clinicopathological diversity of the thrombus and its relationship with primary lesions.

AIM

To propose a new classification for HCC with BDTT in order to guide its diagnosis and treatment.

METHODS

A retrospective review of the diagnosis and treatment experience regarding seven typical HCC patients with BDTT between January 2010 and December 2019 was conducted.

RESULTS

BDTT was preoperatively confirmed by computed tomography/magnetic resonance imaging in only four patients. Three patients with recurrent HCC and one patient with first-occurring HCC had no visible intrahepatic tumors; of these, misdiagnosis occurred in two patients, and three patients died. One patient was mistreated as having common bile duct stones, and another patient with a history of multiple recurrent HCC was misdiagnosed until obvious biliary dilation could be detected. Only one patient who received hepatectomy accompanied by BDTT extraction exhibited disease-free survival during the follow-up period. A new classification was proposed for HCC with BDTT as follows: HCC with microscopic BDTT (Type I); resectable primary or recurrent HCC mass in the liver with BDTT (Type II); BDTT without an obvious HCC mass in the liver (Type III) and BDTT accompanied with unresectable intra- or extrahepatic HCC lesions (Type IV).

CONCLUSION

We herein propose a new classification system for HCC with BDTT to reflect its pathological characteristics and emphasize the significance of primary tumor resectability in its treatment.

The Prognostic Comparison Between Hepatocellular Carcinoma with Portal Vein Tumor Thrombus and Bile Duct Cancer Thrombus After Liver Resection

Background and Objective

Hepatocellular carcinoma (HCC) often invades the portal vein and its branches to form portal vein tumor thrombus (PVTT), and it rarely spreads into the bile ducts to cause bile duct tumor thrombus (BDTT). However, the clinical prognosis of patients with the two types of tumor thrombus is different. In this manuscript, we plan to compare the prognosis of HCC with PVTT and BDTT for further clinical treatment.

Patients and Methods

A total of 60 patients including 48 HCC cases with PVTT and 12 HCC cases with BDTT were enrolled in the study. The medical records were collected from participants. The follow-up was performed in 3 years post-hepatectomy. Statistical analysis was performed to explore the relationship between tumor thrombus with clinicopathological characteristics, to determine the significant preoperative factors influencing overall survival (OS) and time to recurrence (TTR), and to establish the survival and recurrent curves.

Results

HCC with BDTT or PVTT often combined with viral hepatitis B, accompanied by varying degrees of cirrhosis, and high AFP level (68.3%), complete tumor capsule (76.7%), and larger tumor size (85.0%). Furtherly, patients with HCC and BDTT tended to have higher total bilirubin (TB) and more possibility of lymph node metastases. The multivariate Cox hazard analyses also revealed that both tumor size and tumor thrombus could be taken as independent prognostic indicators of HCC patients. Survival curves showed that the 1-, 2- and 3-year OS or DFS rates of HCC patients with BDTT were significantly lower than those of HCC patients with PVTT, respectively.

Conclusion

Tumor thrombus is an independent risk factor for poor survival and high recurrence in HCC. HCC patients with BDTT had shorter overall survival and higher tumor recurrence rate compared to HCC patients with PVTT.

Radiofrequency Ablation of the Main Lesion of Hepatocellular Carcinoma and Bile Duct Tumor Thrombus as a Radical Therapeutic Alternative: Two Case Reports

Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) formation is a rare entity found microscopically in 1% to 9.2% of resected specimens. The ideal treatment for HCC is surgical resection. However, because of poor hepatic functional reserve in patients with HCC, most tumors are unresectable. Here, we report 2 cases of HCC with BDTT type III accompanied by hepatic dysfunction that were successfully treated with radiofrequency (RF) ablation. We used RF ablation as both a radical therapeutic method and an efficient way to control bleeding from the origin of BDTT after BDTT removal. At the time of writing, the 2 patients have been disease-free for 16 and 12 months, respectively.Our results show that RF ablation may be used as a radical therapeutic alternative for HCC with BDTT in patients with liver cirrhosis and obstructive jaundice.