Endoscopy 2011; 43: E232-E233
DOI: 10.1055/s-0030-1256320
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Spontaneous dislodgement of a biliary tumor in a patient with hepatocellular carcinoma

H.  Kogure1 , K.  Miyabayashi1 , T.  Tsujino1 , H.  Isayama1 , R.  Tateishi1 , K.  Koike1
  • 1Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Japan
Further Information

H. KogureMD 

Department of Gastroenterology
Graduate School of Medicine
University of Tokyo

7-3-1 Hongo, Bunkyo-ku
Tokyo 113-8655
Japan

Fax: +81-3-38140021

Email: kogureh-tky@umin.ac.jp

Publication History

Publication Date:
19 July 2011 (online)

Table of Contents

    A 72-year-old woman with Child–Pugh B cirrhosis was hospitalized in our department for transarterial chemoembolization (TACE) for the recurrence of hepatocellular carcinoma with biliary invasion. She had undergone radiofrequency ablation (RFA) therapy 1 year earlier. Contrast-enhanced computed tomography (CT) showed a 15-mm hypervascular tumor in the common hepatic duct adjacent to the area previously treated with RFA ([Fig. 1]).

    Zoom Image

    Fig. 1 Computed tomography (CT) showed a 15-mm hypervascular tumor in the common hepatic duct adjacent to the area previously treated with radiofrequency ablation (RFA) (arrows).

    Subsequent contrast-enhanced ultrasonography with Sonazoid showed a hypervascular pedunculated tumor in the upper extrahepatic bile duct ([Fig. 2]).

    Zoom Image

    Fig. 2 Contrast-enhanced ultrasonography with Sonazoid showed a hypervascular pedunculated tumor in the upper extrahepatic bile duct.

    On admission, the patient was asymptomatic with normal serum bilirubin and biliary enzyme levels. In the morning when TACE was scheduled, however, she developed epigastralgia and vomiting, with elevated serum bilirubin and biliary enzyme levels. CT was performed immediately; the tumor in the common hepatic duct had disappeared, and a lesion with somewhat high density had appeared in the lower part of the common bile duct instead ([Fig. 3]).

    Zoom Image

    Fig. 3 Computed tomography (CT) revealed that: a the tumor in the common hepatic duct had disappeared, and b a lesion with slightly high density (arrow) had appeared in the lower part of the common bile duct instead.

    We suspected that the biliary tumor thrombus had spontaneously migrated to the lower common bile duct and was causing her symptoms. Emergent endoscopic retrograde cholangiopancreatography showed a 9 × 30-mm filling defect in the distal common bile duct ([Fig. 4]).

    Zoom Image

    Fig. 4 A cholangiogram showed a 9 × 30-mm filling defect in the distal common bile duct.

    After endoscopic papillary balloon dilation with a 10-mm balloon, a blackish green tissue was obtained using a retrieval basket catheter ([Fig. 5], [Video 1]).

    Zoom Image

    Fig. 5 An endoscopic image showed the necrotic mass of hepatocellular carcinoma.

    Video 1 After endoscopic papillary balloon dilation, the biliary tumor thrombus was removed using a retrieval basket catheter.

    Histopathological examination revealed hepatocellular carcinoma with extensive necrosis.

    Endoscopy_UCTN_Code_CCL_1AZ_2AC

    Competing interests: None

    H. KogureMD 

    Department of Gastroenterology
    Graduate School of Medicine
    University of Tokyo

    7-3-1 Hongo, Bunkyo-ku
    Tokyo 113-8655
    Japan

    Fax: +81-3-38140021

    Email: kogureh-tky@umin.ac.jp

    H. KogureMD 

    Department of Gastroenterology
    Graduate School of Medicine
    University of Tokyo

    7-3-1 Hongo, Bunkyo-ku
    Tokyo 113-8655
    Japan

    Fax: +81-3-38140021

    Email: kogureh-tky@umin.ac.jp

    Zoom Image

    Fig. 1 Computed tomography (CT) showed a 15-mm hypervascular tumor in the common hepatic duct adjacent to the area previously treated with radiofrequency ablation (RFA) (arrows).

    Zoom Image

    Fig. 2 Contrast-enhanced ultrasonography with Sonazoid showed a hypervascular pedunculated tumor in the upper extrahepatic bile duct.

    Zoom Image

    Fig. 3 Computed tomography (CT) revealed that: a the tumor in the common hepatic duct had disappeared, and b a lesion with slightly high density (arrow) had appeared in the lower part of the common bile duct instead.

    Zoom Image

    Fig. 4 A cholangiogram showed a 9 × 30-mm filling defect in the distal common bile duct.

    Zoom Image

    Fig. 5 An endoscopic image showed the necrotic mass of hepatocellular carcinoma.