Small hepatocellular carcinoma presenting as intrabiliary pedunculated polyp and obstructive jaundice

A rare autopsy case of small hepatocellular carcinoma presenting as an intrabiliary pedunculated mass is reported. The patient, 60-year-old man, presented with obstructive jaundice and died 1 month later. At autopsy, an intrabiliary pedunculated tumor measuring 3.5 x 2.0 x 2.0 cm was found in the hepatic, right hepatic, and right posterior segmental bile ducts. The intraductal tumor was attached to the segmental bile ductal wall, where a tumor measuring 2.0 x 0.9 cm was found in the parenchyma. The parenchymal tumor was continuous with the intrabiliary mass. Histologically, the tumor was a hepatocellular carcinoma showing acidophilic granular cytoplasm with occasional hyaline globules and was structurally arranged in a vague trabecular pattern. Immunohistochemically, tumor cells were positive for alpha-fetoprotein and alpha 1-antitrypsin, but was negative for keratin. We present a brief review of the literature of such icteric hepatocellular carcinomas.