INTERMITTENT BILE-DUCT OBSTRUCTION AS INI TIAL SIGN OF HEPATOCELLULAR-CARCINOMA

History and clinical findings: For two months a 73-year-old woman had been suffering from intermittent colicky upper abdominal pain. She had also noted transient colourless stools and finally jaundice. Suspecte d cholelithiasis led to her admission for cholecystectomy. She had sli ght jaundice of skin and sclerae. Physical findings were unremarkable except for pain on epigastric palpation.Investigations: Sonography and computed tomography showed dilatation of the intrahepatic biliary pas sages and the proximal common bile duct, the latter containing a polyc yclic mass that on endoscopic retrograde cholangiography appeared ovul ar and was surrounded by contrast medium. It was thought to be an intr aductal bile stone. Treatment and course: Laparotomy, performed to rem ove the suspected stone, revealed a floating intraductal tumour, histo logically a hepatocellular carcinoma. Further imaging discovered the p rimary hepatic tumour. Conclusion: Although a smooth-walled contrast-s paring mass in the common bile duct usually denotes a stone, other str uctures may rarely imitate this picture, in particular atypical tumour growth.