Cholangiography of icteric type hepatoma

Icteric type hepatoma caused by floating tumor debris in the major bile duct was rare. Such cases were often incorrectly identified as biliary carcinoma or choledocholithiasis until pathological proof. The goal of this study was to analyze the cholangiograms of icteric type hepatomas, and to identify the characteristic cholangiographic features of this rare disease.

A retrospective analysis of 20 cholangiographies of icteric type hepatomas during a 10-yr period was carried out.

There were 15 males and five females in this series. Seventeen (85%) patients were hepatitis B virus carriers, and liver cirrhosis was detected in 16 (80%) patients. Serum alpha-fetoprotein levels in 13 (65%) of the patients were over 400 ng/ml. The cholangiographic findings included: 1) intraductal filling defects resulting in partial or complete obstruction and ductal dilation in 14 cases (70%), 2) abrupt complete obstruction of the common hepatic duct with an irregular cut surface in three cases (15%), and 3) tumor encasement and stricture of the biliary system in three cases (15%). Management of these patients included hepatic resection, choledochotomies with T tube stenting, or PTCD. Most of them died within one-half year after diagnosis, but one patient in our series, who received hepatic resection, survived more than 70 months.

It is important to recognize this group of patients. Because with proper management, good palliation or cure is possible. The cholangiographic appearances, when taken alone, are not diagnostic of icteric type hepatomas. Once these cholangiograms are seen in patients with associated risks of developing a hepatoma, such as liver cirrhosis, chronic viral hepatitis, and elevated serum alpha-fetoprotein, however, an icteric type hepatoma should be suspected.