Abstract

A hepatocellular carcinoma (HCC) invading the bile duct is an uncommon form and sometimes difficult to differentiate from cholangiocarcinoma. Because of different treatment modality, differential diagnosis of thesetwo diseases should be performed. We experienced an unusual case with HCC with obstructive jaundice caused by the involvement of intrahepatic duct, then confirmed by percutaneous transhepatic cholangioscopic biopsy results. A 60-year-old man was admitted with fever, chills, and an epigastric pain of 5 days duration. The patient had compensated liver cirrhosis as a result of alcohol abuse. Multidetector computed tomography (MDCT) of the abdomen revealed a low attenuated mass associated with bile duct dilation at the fourth segment of the liver. The cholangioscopic finding showed a single, 2-cm, polypoid mass with a yellowish ‘‘chicken fat-like’’ appearance, protruding into the lumen of the fourth branch of the left intrahepatic duct and bleeding easily. A diagnosis of HCC was proven by microscopic examination of the tissue specimen obtained by a cholangioscopic biopsy.

• Keywords: Hepatocellular carcinoma;Cholangioscopy;Biliary tract neoplasm