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Sloughing of biliary tumour ingrowth of hepatocellular carcinoma after chemoembolization

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

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.

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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.

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Authors and Affiliations

  1. Department of Radiology, Research Institute Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Gyoung Min Kim

  2. Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, # 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea

    Hyo-Cheol Kim, Saebeom Hur, Myungsu Lee, Hwan Jun Jae & Jin Wook Chung

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  1. Gyoung Min Kim
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Correspondence to Hyo-Cheol Kim.

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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

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  • DOI: https://doi.org/10.1007/s00330-015-3974-y

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