원발성 간세포암에 의한 폐쇄성황달 - 3 예 보고 - = Obstructive Jaundice Caused by Hepatocellular Carcinoma - Report of three cases

다국어 초록 (Multilingual Abstract)

Jaundice is not uncommonly found as a symptom of hepatocellular carcinoma, particularly in the later stage due to the infiltrating hepatoma or to underlying cirrhosis. It is rare, however, for obstructive jaundice to occur initially and as a presenting symptom secondary to complete obstruction due to the hepatocellular carcinoma in the extrahepatic bile duct. Recently we have had the opportunity to experience three cases with hepatocellular carcinoma in whom jaundice was caused by extrahepatic biliary obstruction. The patients were presented with recurrent and progressive jaundice with or without right upper abdominal pain at admission. All of the three cases had underlying liver cirrhosis with hep- atosplenomegaly on examination with abdominal ultrasonogram and liver scan. ERC was performed in first two cases and showed smooth well defined filling defect in distal common bile duct with accompanying dilatation in one case and well defined filling defect adherant to common hepatic duct in another case. At operation, no tumor was found grossly on the surface of the cirrhotic liver in all cases. The common bile duct was explorated and multiple irregularly shaped yellowish soft tissue (chicken fat) and blood clots were evacuated, These materials revealed pathologically well differentiated hepatocellular carcinoma in all the cases. Abdominal ultrasonogram and ERC of this rare manifestation of hepatocellular carcinoma will help to establish diagnosis before surgery. But because these methods have diagnostic limitation, it is worthwhile to explorate this lesion and any material or hemobilia from the lesion should be confirmed pathologically. Therefore the authors wish to emphasize that the physician should be aware of the presentation with obstructive jaundice including both in intraluminal and extraluminal obstruction as a mechanical complication of hepatocellular carcinoma, especially with underlying liver cirrhosis.