Leave No "Stone" Unturned: Biliary Obstruction From Isolated Intraductal Metastatic HCC

Hepatocellular carcinoma (HCC) metastases to the biliary tree are exceedingly rare. We present a patient with hepatitis C virus (HCV) cirrhosis and recurrent HCC treated previously by locoregional therapy, who presented for Y-90 embolization but was found to have obstructive jaundice. Intraductal biopsy confirmed isolated, metastatic HCC in the distal common bile duct leading to obstruction. Albeit rare, bile duct metastases should be considered in patients with HCC treated by locoregional therapy presenting with obstructive jaundice. To our knowledge, this is the first report of metastatic HCC to the common bile duct in a patient who has not undergone prior partial hepatectomy.