HEPATOCELLULAR-CARCINOMA EMBOLUS TO THE COMMON HEPATIC DUCT WITH NO DETECTABLE PRIMARY HEPATIC TUMOR

Obstruction of the common bile duct (CBD) by direct extension of tumor is occasionally found in patients with hepatic neoplasms. Tumor embol us to the CBD is very rare, however, when no primary hepatic tumor is found. The patient described herein was a 74-year-old man who presente d with a new onset of jaundice, nausea, anorexia, and epigastric pain. There was a history of dark urine and clay-colored stools, but no fev er. Endoscopic retrograde cholangiopancreatography (ERCP) showed parti al obstruction of the common hepatic duct and dilated intrahepatic bil e ducts. A computed tomography (CT) scan of the upper abdomen showed n o masses. Results of a mesenteric and selective hepatic arteriogram we re normal. On abdominal exploration, no tumor was noted. There were no palpable stones in the gallbladder, but a firm mass was felt in the c ommon hepatic duct. Exploration of the CBD produced light-colored debr is organized into a cast of the common hepatic duct. Frozen section an alysis was negative for tumor cells, but review of the permanent secti ons confirmed the presence of hepatocellular carcinoma, When non-calcu lous material is found to be obstructing the CBD, even in the absence of an obvious primary hepatic tumor, tumor embolus or metastasis from a distant site must be considered and the material sent for pathologic al evaluation.