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Journal of the Korean Liver Cancer Study 2008;8(1):64-68.
Published online June 30, 2008.
Poorly Differentiated Hepatocellular Carcinoma with Intraluminal Metastasis to the Bile Duct
Jae Gil Lee1, Yong Il Kim2, Soon Hee Sung3
1Department of Surgery, Yonsei University, College of Medicine
2Department of Surgery, Ewha Womans University, School of Medicine
3Department of Pathology, Ewha Womans University, School of Medicine
Correspondence:  Jae Gil Lee,
Email: jakii@yuhs.ac
Copyright ©2008 by The Korean Liver Cancer Association
Abstract
Stem cells of the liver are differentiated to both hepatocytes and cholangiole. So bidirectional malignant transformation may be occurred. Hepatocellular carcinoma with bile-duct tumor thrombi is clinically rare and cause the obstructive jaundice. We experienced the poorly differentiated hepatocellular carcinoma showed the bidirectional differentiation. And she had metastatic foci in right intrahepatic duct with tumor thrombi to the common bile duct. A 72-year-old female patient was admitted to hospital by pruritus, general weakness and dark urine for 15 days. She was diagnosed liver cirrhosis due to chronic HBV 15 years ago. She showed icteric sclerae. The laboratory findings were followed; total bilirubin/direct bilirubin was 9.7/7.3 mg/dL, SGOT/SGPT was 59/115 IU/L, alkaline phosphatase 681 IU/L, alpha-fetoprotein was 16.9 ng/mL and CA19-9 was 76.2 U/mL. ICG-R15 was 11.8%. The hilar cholangiocarcinoma type IIIa with liver abscess was diagnosed by CT scan and MRI scan. She underwent Rt. hepatectomy with resection of CBD, Roux-en-Y hepaticojejunostomy. After pathologic examination, the poorly differentiated hepatacellular carcinoma with bile duct metastasis was confirmed. Metastasis to right lower lung was detected at 1 years after 1st operation. So, she underwent wedge resection of RLL. She remains without any problems 6 months after 2nd operation.
Key Words: Poorly differentiated hepatocellular carcinoma; Bile duct metastasis; Hepatectomy
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