Three cases of small hepatocellular carcinoma presenting as obstructive jaundice

Abstract

Background: Despite improved diagnostic tools, it is often difficult to make a correct diagnosis of small hepatocellular carcinoma (HCC) in patients with obstructive jaundice.

Case outlines: Three cases of small HCC (<2 cm diameter) presenting as obstructive jaundice are reported. All tumours were initially diagnosed as hilar cholangiocarcinoma based on ultrasonography, computed tomography, cholangiography and angiography. Because of insufficient hepatic function, none of the patients underwent hepatic resection. One patient died 8 months after first admission to our hospital, another died of disseminated intravascular coagulation I month after admission, and the third was treated with hepatic arterial infusion chemotherapy and survived >36 months.

Conclusion: It is important to consider HCC in the diagnosis of obstructive jaundice in patients who are predisposed to HCC because of liver cirrhosis and/or chronic viral hepatitis, and have elevated serum alpha-fetoprotein.

Figure 1.

Case no. 1. (a) CT scan shows an irregular surface of the liver, intrahepatic bile duct dilatation and a heterogeneous mass invading the right hepatic duct. (b) Cholangiography through a percutaneous transhepatic biliary drainage (PTBD) catheter reveals complete obstruction at the hilar area, suggesting a diagnosis of bile duct cancer at the hepatic hilus.

Figure 2.

Case no. 2. (a) CT scan shows dilatation of the left hepatic duct and an isodensity mass filling the bile duct. (b) Cholangiography through the PTBD catheter reveals an intraluminal filling defect in the left hepatic duct and common bile duct, which was diagnosed as bile duct cancer at the hepatic hilus.

Figure 3.

Case no. 3. Magnetic resonance cholangiography (MRCP) showing a bile duct stricture at the hepatic hilus.