Abstract
Purpose
To describe the imaging findings and clinical course of sloughing of biliary tumour ingrowth of hepatocellular carcinoma (HCC) after chemoembolization.
Materials and methods
We reviewed 12 patients who experienced sloughing of biliary tumour ingrowth after chemoembolization. We evaluated the patients’ characteristics, clinical manifestations and treatment modalities. We also reviewed computed tomography (CT) scans to determine the characteristics of the sloughed tumour including length, attenuation and appearances during follow-up.
Results
The length of the sloughed tumour ranged from 0.6–7.8 cm. Their Hounsfield units ranged from 35–729. Sloughed tumours were misreported as biliary stones in four patients, and were not reported in the initial CT report in one patient. At the time of sloughing, seven patients complained of cholestatic symptoms, while the other five had no symptoms. Four patients underwent sphincterotomy and tumour removal under endoscopic retrograde cholangiopancreaticography (ERCP), two underwent percutaneous transhepatic biliary drainage (PTBD) and one underwent PTBD followed by ERCP. The remaining five were managed conservatively. Five sloughed tumours were removed by ERCP, six disappeared spontaneously within 3 months, and one patient had no follow-up image.
Conclusions
Sloughing of biliary tumour ingrowth may be misinterpreted as biliary stone, and may or may not cause cholestatic symptoms.
Key Points
• Migration of intraductal tumour ingrowth of HCC after chemoembolization occurs more commonly than reported.
• The sloughed tumour is often misinterpreted as biliary calculi.
• It can make cholestasis and be managed by ERCP or PTBD.
• In some asymptomatic cases, a wait-and-see approach can be taken.
Similar content being viewed by others
References
Lin TY, Chen KM, Chen YR, Lin WS, Wang TH, Sung JL (1975) Icteric type hepatoma. Med Chir Dig 4:267–270
Huang JF, Wang LY, Lin ZY et al (2002) Incidence and clinical outcome of icteric type hepatocellular carcinoma. J Gastroenterol Hepatol 17:190–195
Qin LX, Ma ZC, Wu ZQ et al (2004) Diagnosis and surgical treatments of hepatocellular carcinoma with tumor thrombosis in bile duct: experience of 34 patients. World J Gastroenterol 10:1397–1401
Satoh S, Ikai I, Honda G et al (2000) Clinicopathologic evaluation of hepatocellular carcinoma with bile duct thrombi. Surgery 128:779–783
Moon DB, Hwang S, Wang HJ et al (2013) Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: a Korean multicenter study. World J Surg 37:443–451
Kitagawa K, Yamakado K, Nakatsuka A et al (1999) Selective transcatheter hepatic arterial chemoembolization for hemobilia from hepatocellular carcinoma: report of three cases. J Vasc Interv Radiol 10:1357–1360
Choi JW, Chung JW, Cho YK et al (2015) Transarterial chemoembolization for hepatocellular carcinomas with central bile duct invasion: safety, prognosis, and predictive factors. Cardiovasc Intervent Radiol. 38:937-945. doi:10.1007/s00270–014-1032–1039
Choi J, Ryu JK, Lee SH et al (2013) Palliative treatment of unresectable hepatocellular carcinoma with obstructive jaundice using biliary drainage with subsequent transarterial chemoembolization. J Palliat Med 16:1026–1033
Shiina S, Komatsu Y, Kawabe T et al (1992) Cholestatic hepatocellular carcinoma diagnosed by deposits of Lipiodol and treated by combination of endoscopic retrograde biliary drainage and transcatheter arterial embolization. J Gastroenterol Hepatol 7:154–156
Spahr L, Frossard JL, Felley C, Brundler MA, Majno PE, Hadengue A (2000) Biliary migration of hepatocellular carcinoma fragment after transcatheter arterial chemoembolization therapy. Eur J Gastroenterol Hepatol 12:243–244
Hiraki T, Sakurai J, Gobara H et al (2006) Sloughing of intraductal tumor thrombus of hepatocellular carcinoma after transcatheter chemoembolization causing obstructive jaundice and acute pancreatitis. J Vasc Interv Radiol 17:583–585
Choi KH, Cho YK, An JK, Woo JJ, Kim HS, Choi YS (2009) Acute obstructive cholangitis after transarterial chemoembolization: the effect of percutaneous transhepatic removal of tumor fragment. Korean J Radiol 10:197–201
Okuda M, Miyayama S, Yamashiro M et al (2010) Sloughing of intraductal tumor thrombus of hepatocellular carcinoma after transcatheter arterial chemoembolization. Cardiovasc Intervent Radiol 33:619–623
Ridtitid W, Chittmittrapap S, Kriengkirakul C, Kongkam P, Janchai A, Rerknimitr R (2010) Lipiodol as a marker for hepatocellular carcinoma migrating into the bile duct. Endoscopy 42:E233–E234
Kogure H, Miyabayashi K, Tsujino T, Isayama H, Tateishi R, Koike K (2011) Spontaneous dislodgement of a biliary tumor in a patient with hepatocellular carcinoma. Endoscopy 43:E232–E233
Sasaki T, Takahara N, Kawaguchi Y et al (2012) Biliary tumor thrombus of hepatocellular carcinoma containing lipiodol mimicking a calcified bile duct stone. Endoscopy 44:E250–E251
Matsumoto K, Osanai M, Maguchi H (2014) Biliary tumor fragment of hepatocellular carcinoma containing lipiodol mimicking a bile duct stone. Dig Endosc 26:295–296
Park HC, Park HB, Chung CY et al (2014) Acute obstructive cholangitis complicated by tumor migration after transarterial chemoembolization: a case report and literature review. Korean J Gastroenterol 63:171–175
Kojiro M, Kawabata K, Kawano Y, Shirai F, Takemoto N, Nakashima T (1982) Hepatocellular carcinoma presenting as intrabile duct tumor growth: a clinicopathologic study of 24 cases. Cancer 49:2144–2147
Hickman MS, Schwesinger WH, Bova JD, Kurtin WE (1986) Computed tomographic analysis of gallstones. An in vitro study. Arch Surg 121:289–291
Acknowledgements
The scientific guarantor of this publication is Hyo-Cheol Kim. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2013R1A1A2A10011007). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. No study subjects or cohorts have been previously reported in others.
Methodology: retrospective, observational, performed at one institution.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kim, G.M., Kim, HC., Hur, S. et al. Sloughing of biliary tumour ingrowth of hepatocellular carcinoma after chemoembolization. Eur Radiol 26, 1760–1765 (2016). https://doi.org/10.1007/s00330-015-3974-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-015-3974-y