Rupture of Hepatocellular Carcinoma into the Biliary System with Resulting Bile Duct Thrombi: Report of Two Cases

Abstract

We report two cases of hepatocellular carcinoma revealed by jaundice and the presence of free-floating tumoural fragments within the biliary system. Two men (one of 64 and one of 73) presented with isolated jaundice. The results from ultrasound, CT and MRI were suggestive of a cholangiocarcinoma. Surgical intervention demonstrated bile duct thrombi from the primary tumour causing obstructive jaundice.

The efficacy of the combination of percutaneous transhepatic biliary drainage and 125I stranded seeds for malignant bile duct obstruction treatment

“…In the past, non-surgical treatments such as PTBD or stent implantation have been employed as a palliative approach to improve bile drainage [13,14]. The use of these approaches is, however, accompanied by a risk of occlusion and is limited in its ability to inhibit tumor growth [15,16].…”

“…In addition, 125 I stranded seeds migration and 125 I seeds dislocation did not appear during follow-up in group A. Iodine-125 is a low-energy radioisotope that is sufficient to provide a robust local radiation dose and good curative effect while causing minimal extraneous damage. This was a result of the effective range of 125 I seeds being ~1.7 cm, such that surrounding normal tissue only received ≤ 25% of radioactive dose received by tumor cells [14,25].…”

“…The observed reduction in bilirubin in group A was more pronounced than group B, with the likely explanation being that the patients in group A had undergone implantation with 125 I seeds. This implantation provided sustained localized irradiation to inhibit tumor growth and tissue hyperplasia, achieving long-term maintenance of normal bilirubin levels [14]. The excretion of bile was not itself affected by the 125 I stranded seeds.…”

“…The increased bilirubin observed after PTBD may be due to tumor ingrowth, tissue hyperplasia, sludge formation, or secondary biliary cirrhosis [ 14 , 26 ]. The observed reduction in bilirubin in group A was more pronounced than group B, with the likely explanation being that the patients in group A had undergone implantation with 125 I seeds.…”

“…Through γ-ray-mediated induction of tumor cell cycle arrest and inhibition of tumor angiogenesis, the goal of suppressing bile duct endothelial hyperplasia and disrupting the growth of cancerous cells are possible to achieve [ 33 , 34 , 35 , 36 ]. In addition, 125 I seeds deliver sustained irradiation to the tumor and can further oxygenize hypoxic cells, causing the tumor to become more sensitive to intracavitary brachytherapy, thus enhancing treatment efficacy [ 14 ]. Additionally, 125 I stranded seeds implantation offers the advantage of extended period of remission for those suffering from obstructive jaundice, thereby improving patient liver function and performance, delaying disease progression, and prolonging overall survival [ 31 ].…”