Clinicopathologic Characteristics of Hepatocellular Carcinoma with Bile Duct Invasion

Abstract

To clarify the characteristics of hepatocellular carcinoma (HCC) with bile duct invasion, we retrospectively analyzed clinical features and surgical outcome of HCC with bile duct invasion (b(+) group, n = 15) compared to those without bile duct invasion (b(-) group, n = 256). In the b(+) group, four patients (27%) showed obstructive jaundice, and a diagnosis of bile duct invasion was obtained preoperatively in seven patients (47%). The levels of serum bilirubin and carbohydrate antigen 19-9 were significantly higher in the b(+) group. Macroscopically, confluent multinodular type and infiltrative type were predominant in the b(+) group (P = 0.002). Microscopically, capsule infiltration (P = 0.040) and intrahepatic metastasis (P = 0.013) were predominant in the b(+) group. Portal vein invasion was associated significantly with the b(+) group (P = 0.004); however, the frequency of hepatic vein invasion was similar (P = 0.096). The median survival after resection was significantly shorter in the b(+) group than in the b(-) group (11.4 vs. 56.1 months, P = 0.002), and eight of 11 intrahepatic recurrences in the b(+) group occurred within 3 months after surgery. HCC with bile duct invasion has an infiltrative nature and a high risk of intrahepatic recurrence, resulting in poor prognosis.

Hepatocellular Carcinoma with Bile Duct Tumor Thrombi (Icteric Hepatoma)– A 19 Year Experience from a Tertiary Care Centre

“…Early recurrence has been associated with poor prognosis (20) . Ikenga et al (17) , Qin et al (7) , Noda et al (21) , Shao et al (22) and Zeng et al (18) -all these studies reported > 50 % recurrence in less than one year. In our study we observed early recurrence in 20 cases.…”

“…Recurrences were noted even in cases without vascular invasion. Shao et al (22) and Ikenaga et al (17) demonstrated tumor recurrences in cases without evidence of major vascular invasion. This indicates that dissemination via bile duct route could be another possible cause for recurrence.…”

“…Most of the studies in literature supports the fact that HCC with bile duct invasion have worse prognosis than HCC without bile duct invasion. (16,17,18,19) . Long term survival in patients with HCC and BDTT is significantly less than patients without bile duct tumor thrombi.…”

Hepatocellular Carcinoma With Bile Duct Invasion Presenting as Acute Cholangitis

“…Tumor thrombus in the bile duct in HCC is rare (0.79-5.5%) and the most common clinical manifestations are obstructive jaundice, abdominal pain, recurrent cholangitis or hemobilia. Biliary thrombi may be secondary to invasion of a primary liver tumor or due to a primary HCC arising on ectopic liver tissue located in the bile duct (2).…”

Quantitative morphometric analysis of hepatocellular carcinoma: programmed algorithm development and preliminary application

“…HCC may manifest a variety of gross morphologies, including nodular, nodular with perinodular extension, multinodular confluent, and infiltrative types (15); each morphology is associated with different degrees of malignancy and variable clinical outcomes (16)(17)(18). While some HCC shapes, such as focal nodular varieties, have been associated with more favorable prognoses (19), other HCC morphologies, such as infiltrative and multinodular confluent forms, have been linked to poor patient survival (20,21). Current HCC morphologic imaging assessment is limited to subjective and qualitative descriptions, which may be confounded by inter-observer variation and lack the measurable parameters that allow reproducible tumor morphologic descriptions, numerical comparisons of tumor shapes, and the association of tumor contour descriptors with clinical outcomes.…”