Migrated tumour fragments in common bile ducts from hepatocellular carcinoma

Death from hepatocellular carcinoma (HCC) is often heralded by the appearance of jaundice which is usually the result of extensive parenchymal damage from either progressive cirrhosis or diffuse tumour infiltration. In rare cases, patients with HCC may present with obstructive jaundice caused by migrated tumour fragments in the common bile ducts. We report three such patients. One patient underwent repeated palliative surgical and endoscopic procedures to clear the bile ducts of tumour fragments. He returned to a normal life but finally succumbed to the disease 17 months after diagnosis. Two patients underwent major hepatic resection after initial tube decompression of the obstructed bile ducts. One patient was found to have recurrence of the tumour 17 months after surgery and the other patient was well and disease-free 24 months after surgery. It is important to recognize and treat this group of patients with migrated tumour fragments in the common bile ducts, as good palliation and occasional cure are possible.