Acute Obstructive Cholangitis Complicated by Tumor Migration after Transarterial Chemoembolization: A Case Report and Literature Review.
10.4166/kjg.2014.63.3.171
- Author:
Hyung Chul PARK
1
;
Hyun Bum PARK
;
Cho Yun CHUNG
;
Min Woo JUNG
;
Young Eun JOO
;
Sung Kyu CHOI
;
Sung Bum CHO
Author Information
1. Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. portalvein@naver.com
- Publication Type:Case Reports ; Review
- Keywords:
Hepatocellular carcinoma;
Biliary obstruction;
Chemoembolization;
Migration;
Bile duct
- MeSH:
Acute Disease;
Aged;
Antineoplastic Agents/administration & dosage;
Bile Ducts, Intrahepatic/pathology;
Carcinoma, Hepatocellular/*diagnosis/pathology/therapy;
Chemoembolization, Therapeutic/adverse effects;
Cholangiopancreatography, Endoscopic Retrograde;
Cholangitis/*etiology;
Humans;
Jaundice, Obstructive/etiology;
Liver Neoplasms/*diagnosis/pathology/therapy;
Male;
Necrosis/pathology;
Sphincterotomy, Endoscopic;
Thrombosis/etiology;
Tomography, X-Ray Computed
- From:The Korean Journal of Gastroenterology
2014;63(3):171-175
- CountryRepublic of Korea
- Language:English
-
Abstract:
Intraductal tumor invasion of hepatocellular carcinoma (HCC) is considered rare. Transarterial chemoembolization (TACE) is effective for tumor thrombus of HCC in the bile duct. However, a few cases of obstructive jaundice caused by migration of a tumor fragment after TACE have recently been reported. The aim of this study was to identify factors that affect tumor migration after TACE. At this writing, a review of the medical literature disclosed seven reported cases of biliary obstruction caused by migration of a necrotic tumor cast after TACE. We, herein, report on an additional case of acute obstructive cholangitis complicated by migration of a necrotic tumor cast after TACE for intrabile duct invasion of HCC, in a 71-year-old man. The tumor cast in the common bile duct was removed successfully using a basket during ERCP and was pathologically confirmed to be a completely necrotic fragment of HCC. The patient's symptoms showed dramatic improvement. In summary, physicians should be aware of acute obstructive cholangitis complicated by tumor migration in a patient undergoing TACE. We suggest that an intrabile duct invasion would be a major predisposing factor of tumor migration after TACE and drainage procedures such as ERCP or percutaneous transbiliary drainage could be effective treatment modalities in these patients.
