Hepatocellular carcinoma with massive bile duct tumor thrombus: report of a long-term survival

A clinicopathological analysis of a case with long-term survival after surgical resection for hepatocellular carcinoma (HCC) with massive bile duct tumor thrombus (BDTT) is presented. A 73-year-old female, who was hepatitis C antibody-positive, was referred to our hospital for jaundice. She had a history of small HCC in segment 4 of the liver, which was treated by percutaneous ethanol injection therapy 5 years previously. Contrast-enhanced magnetic resonance imaging detected the primary tumor in segment 4, and a BDTT in the common bile duct with dilatation of the intrahepatic bile duct. Percutaneous transhepatic cholangiography revealed a defect from the bilateral hepatic ducts to the middle part of the common bile duct. Left lobectomy of the liver with thrombectomy and local bile duct resection was performed. The patient has remained alive with no sign of recurrence for 5 years since the surgery. Here, we describe this case of HCC with BDTT showing long-term survival and the usefulness of curative surgical resection with removal of the tumor thrombus.