Bile Duct Tumor Thrombus Research Articles

The endoscopic retrograde cholangiopancreatographic manifestations of histopathologically diagnosed hepatocellular carcinoma with obstructive jaundice.

To study the manifestations of endoscopic retrograde cholangiopancreatography (ERCP) in patients of obstructive jaundice associated with HCC, 32 cases of histopathologically diagnosed HCC with obstructive jaundice were successfully examined with routine ERCP. 31 patients were demonstrated by ERCP as having malignant obstructive jaundice. Among them, 19 were hepatic perihilar bile duct stricture, 7 bile ductile tumorous thrombus, 3 perihilar bile duct stricture complicated with thrombus, 2 metastasis to hilar lymph node, and 1 common bile duct stone as proven by sphincterotomy. The malignant perihilar stricture was all of type III and IV by Bismuth standard of Klastin tumor. In patients identified as having bile duct tumor thrombus, by the Ueda classification, none was of type I and II; 1 type III a; 4 III b; 2 type IV. HCC with obstructive jaundice was mainly caused by the malignant infiltration of tumor, and most stricture was of serious nature. When major extra-hepatic bile duct was involved by tumor thrombus, obstructive jaundice might develop. Malignant perihilar stricture and tumor thrombus might coexist in some patients. Jaundice was rarely caused by hepatic hilar lymph node metastasis. Jaundice was not necessarily caused by tumors and sometimes, it might be caused by common bile stones. Care should be exercised in differentiation diagnosis in such patients.

Color Doppler sonography of bile duct tumor thrombi in hepatocellular carcinoma.

To determine with the use of color Doppler sonography whether bile duct tumor thrombi had detectable vasculature in hepatocellular carcinoma. Among 491 patients with tissue-proven hepatocellular carcinoma, 9 (1.8%) had bile duct tumor thrombi. All 9 patients had spectral Doppler sonography guided by color Doppler sonography (3.75-MHz convex probe). All 9 patients had dilated bile ducts with isoechoic thrombi. Eight patients had tumors infiltrating into and obstructing adjacent major bile ducts. The other patient had common hepatic duct tumor emboli that were not adjacent to primary tumors. Color signals were detectable within bile duct tumor thrombi in 7 patients. All of them had pulsatile waveforms on spectral analyses. Bile duct tumor thrombosis with obstructive jaundice was a rare complication of hepatocellular carcinoma. A detectable color signal with pulsatile waveforms was shown in most cases by color Doppler sonography with spectral analyses.

Gallbladder carcinoma with a tumor thrombus in the common bile duct: An unusual cause of obstructive jaundice

A 47-year-old man was admitted to our hospital complaining of epigastralgia and jaundice that had been present for 7 days. Laboratory tests revealed elevated levels of serum total bilirubin (13.5 mg/dL; normal, 0.3-1.3), alkaline phosphatase (871 U/L; normal, 60-201), and carbohydrate antigen 19-9 (CA19-9) (460 U/mL; normal, 0-37). Imaging modalities showed a tumor of the gallbladder with intrahepatic bile duct dilatation. Subsequently, percutaneous transhepatic biliary drainage was carried out: Cholangiography showed a filling defect in the common bile duct with no irregularity of the wall (Figure).