Journal of Liver Cancer

Case Reports

A Case of Hypovascular Hepatocellular Carcinoma Invading Bile Duct with Partial Remission with Combination Therapy of Transarterial Chemoembolization and Stereotactic Body Radiation Therapy and Sorafenib: Sang Youn Hwang, Seon-Mi Lee, Jung Woo Im, Joon Suk Kim, Sang Bu Ahn, Eun Kyeong Ji, Chul Won Choi, Gwang-Mo Yang; Journal of the Korean Liver Cancer Study Group. 2013;13(2):178-184. Published online September 30, 2013; DOI: https://doi.org/10.17998/jlc.13.2.178

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Abstract PDF: Hepatocellular carcinoma (HCC) patients with bile duct invasion have a poor prognosis because many do not receive effective treatment. Surgical resection is thought to be only option of curative treatment, increasing chance of survival, but it is possible to minor group of patients because of poor reserved liver function associated with underlying liver disease and obstructive jaundice. Therefore many clinicians or centers still select locoregional therapy such as transarterial chemoembolization (TACE), radiation therapy (RT) etc. Stereotactic body radiation therapy (SBRT) is new technology providing very highly conformal ablative radiation dose for a small numbers (1-5 fractions) of large fraction size and is expected to salvage modality for HCC showed incomplete response of TACE due to vascularity or accessibility of feeding artery. Based on above suggestions, we herein offer our experience of a patient with partial remission of tumor by combination therapy of TACE, SBRT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic therapy (so called multidisciplinary approach), is necessary on how to manage HCC patients with bile duct invasion or sparse vascularity.

A Case of the Effective Treatment of HCC with Bile Duct Invasion and Portal Vein Thrombosis: Jihyun An, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Young-Hwa Chung, Yung Sang Lee; Journal of the Korean Liver Cancer Study Group. 2013;13(2):169-172. Published online September 30, 2013; DOI: https://doi.org/10.17998/jlc.13.2.169

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Abstract PDF: Bile duct invasion of hepatocellular caricinoma (HCC) is rare, ranging from 1.2% to 9%. Moreover, the standard treatment of HCC with bile duct invasion is not yet established. We report a case of HCC with bile duct invasion and portal vein thrombosis which was successfully treated by trasarterial chemoembolization and radiotherapy. A 38-year-old female patient visited our hospital due to right upper quadrant pain. The level of total and direct bilirubin was 6.8 and 4.0 mg/dL, respectively. Her blood test showed HBs Ag positive and the level of alpha-fetoprotein was 43,000 ng/mL. Her CT scan revealed lobulating hypervascular mass involving right hepatic lobe, portal vein and both intrahepatic ducts. We performed endoscopic biliary drainage using biliary stent. She had been diagnosed as HCC on endobiliary biopsy. She was treated with radiotherapy (RT) to portal vein thrombosis, and seven transarterial chemoembolizations. After of all, we carried out radiotherapy to hepatic vein thrombosis and residual HCC near hepatic vein. After the RT, she has been taken care at outpatient clinic without evidence of recurrence during 8 months.

A Case of Good Responsed Bile Duct Invasion of Hepatocellular Carcinoma on Cyberknife Therapy: Dae Han Choi, Jae Young Jang, Soung Won Jeong, Sae Hwan Lee, Sang Gyune Kim, Young Seok Kim, Hong Soo Kim, Boo Sung Kim, A ram Jang; Journal of the Korean Liver Cancer Study Group. 2013;13(1):70-73. Published online February 28, 2013; DOI: https://doi.org/10.17998/jlc.13.1.70

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Abstract PDF: Hepatocellular carcinoma (HCC) is one of the common tumor worldwide and recorded as third most common cause of cancer-related deaths. Invasion of the portal and hepatic veins by HCC is common. But intrabiliary invasion is rare. Radiotherapy (RT) is considered appropriate for unresectable, locally advanced HCC without extrahepatic metastasis. With the conventional RT, it is not possible to deliver a high radiation dose to a treatment volume in a short time and narrow lesion. Recent technological developments in radiation therapy, such as stereotactic body radiation therapy (SBRT), make it possible to deliver a substantial dose of radiation to the tumor and avoid radiosensitive normal liver in the vincinity. We report a patient who were treated by cyberknife therapy for bile duct invasion of progressing HCC despite of treatment.

A Case of Hepatocellular Carcinoma with Bile Duct Invasion Surgically Resected after Transarterial Chemoembolization; Curative Resection after Tumor Downstaging: Nae-Yun Heo, Han Chu Lee, Ju Hyun Shim, Kang Mo Kim, Young Suk Lim, Young-Hwa Chung, Yung Sang Lee, Dong Jin Suh; Journal of the Korean Liver Cancer Study Group. 2011;11(1):69-74. Published online February 28, 2011

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Abstract PDF: A surgical resection is a major curative treatment of hepatocellular carcinoma (HCC) in Korea. However, the respectability of HCC at the time of diagnosis is low (10-30%) because the cancer is often identified as advanced stage. Nevertheless, some of the patients were known to have a curative resection after successful downstaging therapy. We report a HCC with bile duct invasion which was successfully downstaged by the transarterial chemoembolization and treated by surgical resection.

A Case of Hepatocellular Carcinoma with Bile Duct Invasion: Danbi Lee, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Young-Hwa Chung, Yung Sang Lee, Dong Jin Suh; Journal of the Korean Liver Cancer Study Group. 2008;8(1):55-58. Published online June 30, 2008

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Abstract PDF: Bile duct invasion of hepatocellular carcinoma (HCC) is rare, ranging from 1.2% to 9 %. A 51-year-old male patient visited our hospital due to jaundice. He had been infected with hepatitis B virus. He had icteric sclera without abdominal distension or tenderness. The level of total and direct bilirubin was 16.7 and 7.8 mg/dL, each other. The level of AFP was 4690 ng/mL. CT scan showed ill-defined hypervascular mass involving left hepatic lobe, left intrahepatic duct and common hepatic duct. He had been diagnosed as HCC on liver biopsy. We performed total 3 PTBDs in right, left lateral, and left medial side of the bile duct. After then, he was treated with two transarterial chemoembolizations. Finally, we carried out extended left lobectomy. After the surgery, he has been taken care at OPD without evidence of recurrence during 8 months.

A Case of Hepatocellular Carcinoma with Invasion to Bile Duct: Hyun Seok Cho, Joo Hyun Sohn, Tae Jun Byun, Sang Bong Ahn, Tae Yeob Kim, Chang Soo Eun, Yong Cheol Jeon, Dong Soo Han; Journal of the Korean Liver Cancer Study Group. 2008;8(1):59-63. Published online June 30, 2008

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Abstract PDF: A 59-year-old male patient with chronic hepatitis B and liver cirrhosis was admitted due to fever and right upper quadrant (RUQ) pain. Two years ago, he had been diagnosed with hepatocellular carcinoma with bile duct invasion and underwent left lateral segmentectomy of liver and cholecystectomy. One year after, hepatocellular carcinoma recurred in the 4th and 5th segments and transarterial chemoembolization was done for them 3 times at 2 or 3 month intervals. On this visit, he complained of general weakness, RUQ pain, fever, and weight loss. Total bilirubin was 3.1 mg/dL, ALT/AST was 81/109 IU/L, and AFP was 2.14 ng/mL. Abdomen computed tomography showed diffuse dilatation of both intrahepatic bile ducts and several small low density lesions with rim enhancement in the 4th and 8th segments. Cholangitis with liver abscesses was suspected and treatment with antibiotics started. ERCP showed narrowing of proximal and hilar portions of common bile duct and irregular shaped filling defects in the right anterior, posterior and left medial portion of intrahepatic ducts, which were believed as tumor thrombi. Despite of endoscopic retrograde biliary drainage, he died of aggravated biliary sepsis and hepatic failure.

A Case of Hepatocellular Carcinoma with Bile Duct Invasion: Yeon Seok Seo, Beom Jin Park, Yun Hwan Kim, Soon Ho Um; Journal of the Korean Liver Cancer Study Group. 2008;8(1):69-73. Published online June 30, 2008

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Abstract PDF: Cholestatic type hepatocellular carcinoma (HCC), in which obstructive jaundice is presented as the initial presentation of HCC, is rare. The prognosis of cholestatic type HCC is generally poor and most of the patients die from cholangitis or sepsis. Although some authors reported cases of successfully treated cholestatic type HCC with surgical resection, most of the patients are inoperable at the time of diagnosis. Several reports suggested that transarterial chemoembolization (TACE) showed a beneficial effect in improving the survival time and therefore, TACE should be tried as a first choice of therapy in patients with cholestatic HCC with sufficient liver reserve function. We experienced a case of obstructive jaundice as the initial presentation of HCC. His obstructive jaundice showed significant improvement after several sessions of TACE.

A Case of Localized Concurrent Chemo-radiation Therapy Using with Tomotherapy for Hilar Hepatocellular Carcinoma with Invasion of Bilateral Bile Duct: Ki Tae Yoon, Do Young Kim, Jin Sil Seong, Jun Yong Park, Jong Won Choi, Sang Hoon Ahn, Kwang-Hyub Han, Chae Yoon Chon; Journal of the Korean Liver Cancer Study Group. 2008;8(1):102-105. Published online June 30, 2008

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Abstract PDF: Hepatocellular carcinoma (HCC) usually takes an intrahepatic spread via portal vein branches, and the incidence of portal vein invasion is reported to be 34～40% in surgical resected series. On the other hand, the rate of intrabiliary growth of HCC is rare, ranging from 2.3～13% in surgical and autopsy cases. Here, we report a case of the patient treated with localized concurrent chemo-radiation therapy (CCRT) for hilar HCC with invasion of bilateral bile duct. The tomotherapy was performed with a total radiation dose of 4,240 cGy (20 times, 212 cGy/time) on tumor bed and hepatic arterial infusion of 5-fluorouracil (1,000 mg/day, day 1～5 and day 16～20) and cisplatin (60 mg/m2, day 3 and day 18) was done via implantable port system during the radiotherapy. After that, tumor size and tumor marker was decreased and treatment response was achieved as partial response. CCRT is expected as one of the appropriated treatment options for inoperable HCC with bile duct invasion.

Hepatocellular Carcinoma with Extrahepatic Bile Duct Invasion: Correlation of Radiologic and Pathologic Findings: Sun Woo Bang, Ho Kyun Kim, Hyuck Sang Lee, Mee Joo, Hye Kyung Lee; Journal of the Korean Liver Cancer Study Group. 2001;1(1):68-71. Published online June 30, 2001

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A Case of Hepatocellular Carcinoma of Intrahepatic Duct Invasion Treated with Early Surgical Resection: Woo Chul Chung, Young Min Park, Si Hyun Bae, Jong Young Choi, Doo Ho Park, Dong Goo Kim; Journal of the Korean Liver Cancer Study Group. 2001;1(1):72-76. Published online June 30, 2001

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Abstract PDF: A 40-year old patient with chronic hepatitis B was admitted to our hospital due to right quardrant abdominal pain and jaundice for 2 days. One month ago, he had been treated for acute cholangitis. Total bilirubin was 6.69 mg/dL, AST/ALT level 150/165 IU/L, and AFP 6.7ng/mL. Abdomen CT showed that diffusely irregular tortuous dilatation of IHBD was noted in S 6, more markedly in the peripheral portion, with rather higher density than fluid within lumen, suggesting mucin producing biliary tumor. ERCP demonstrated that a long segment movable filling defect was present at CHD, proximal CBD and posterior right intrahepatic duct. Suggesting sludge and posterior inferior segment of right intrahepatic duct was not visualized with filling defects. At that point we suspected that his diagnosis was cholangiocarcinoma. So we carried out the surgical resection. The pathologic results were hepatocellular carcinoma with bile duct invasion. Because of the incomplete resection of hepatocellular carcinoma, TAC was performed twice during the next 2 months. After then he has been taken care at OPD with good condition. This case shows that hepatocellular carcinoma is early detected by bile duct dilatation on CT and successfully treated by surgical intervention and TAC.

A case of Hepatocellular Carcinoma with Bile Duct Invasion Treated with Transcather Arterial Embolization and Surgical Resection: Joon Woo Lee, Joon Koo Han, Byung Ihn Choi; Journal of the Korean Liver Cancer Study Group. 2001;1(1):77-79. Published online June 30, 2001

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Abstract PDF: A 51-year-old-male was admitted due to epigastric discomfort. He had history of alcoholism. Physical findings revealed that he had tenderness on right upper quadrant with jaundice. Total bilirubin was 8.3 mg/dL, AST/ALT was 40/53 IU/L, and AFP was 38,925 ng/ml. Computed tomography showed ill-defined mass in the right hepatic lobe and intraductal mass measuring 3cm in diameter in common bile duct. PTBD was performed via B3 and on cholangiogram, there was abrupt cut-off at confluence level of common hepatic duct. After PTBD, jaundice was relieved. After then, TACE and surgical resection was done. There was a large mass measuring 6cm in the right hepatic lobe with intraductal extention to common bile duct. After then, the patient survives 30 months up to date and is still alive.

A Case of Hepatocellular Carcinoma with Bile Duct Invasion: Seung Min Bang, Hye Won Chung, Jae Youn Cheong, Chung Ryul Lee, Kun Hoon Song, Kwang Hyub Han, Chae Yoon Cheon, Young Myoung Moon, Sung Il Park, Do Yun Lee, Jong Tae Lee; Journal of the Korean Liver Cancer Study Group. 2001;1(1):85-88. Published online June 30, 2001

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Abstract PDF: A 52 year-old female patient with liver cirrhosis admitted due to icteric skin color for 3 weeks. Four months ago, she had been diagnosed as hepatocellular carcinoma(HCC), and treated with transarterial chemoembolization(TACE) at another hospital. Physical findings revealed that she had icteric sclera without ascites or palpable hepatosplenomegaly. Total bilirubin was 6.0mg/dL, ALT/AST was 117/111 IU/L. Computed tomography showed 3cm sized nodular mass involving left lateral segment of the liver and left intrahepatic bile duct. Endoscopic retrograde cholangiopancreatography(ERCP) revealed filling defect of left intrahepaitc duct and common hepatic duct, suggesting left intrahepatic duct and common hepatic duct invasion of HCC. After endoscopic retrograde biliary drainage(ERBD) with stent insertion, total bilirubin was decreased and clinical symptoms were improved. She was treated with TACE using adriamycin after ERBD. Thereafter, she was prescribed oral 5-fluorouracil and treated with external radiotherapy(4,500cGy). Five months later after the treatment, CT scan showed decrease in tumor size, and jaundice was improved as well.

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