HEPATOCELLULAR-CARCINOMA COMPLICATED WITH COEXISTING HEPATOLITHIASIS PITFALLS IN DIAGNOSIS AND MANAGEMENT - PITFALLS IN DIAGNOSIS AND MANAGEMENT

Nineteen patients with hepatocellular carcinoma associated with hepato lithiasis were retrospectively analyzed. Eleven of the 19 patients pre sented with hepatolithiasis-related biliary infection. Diagnosis was e rroneously assumed to be hepatolithiasis alone, liver abscess, or chol angiocarcinoma in five of 11 patients before surgery was attempted. Mi ddle-age, male sex, liver cirrhosis, hepatitis B or C infection, abnor mal cr-fetoprotein, and negative carcinoembryonic antigen raised the s uspicion of associated hepatocellular carcinoma rather than cholangioc arcinoma in patients with hepatolithiasis. Antibiotics and nonoperativ e methods to resolve biliary infection first, followed by hepatectomy, in selected cases, to eradicate hepatocellular carcinoma and hepatoli thiasis simultaneously provides the best chance for long-term survival . Otherwise, patients often died of hepatolithiasis-related biliary se psis rather than hepatocellular carcinoma per se in the long run.