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A rare cause of obstructive jaundice in a patient with hepatocellular carcinoma

  • Se Young Ryou
    Affiliations
    Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
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  • Pil Soo Sung
    Correspondence
    Corresponding author at: Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, 06591 Seoul, Korea.
    Affiliations
    Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea

    The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
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Published:August 20, 2022DOI:https://doi.org/10.1016/j.dld.2022.08.015
      A 60-year-old male with known hepatocellular carcinoma (HCC) and hepatitis B, who was taking entecavir and had a history of 10 times transarterial chemoembolization (TACE) procedures, presented with severe abdominal pain to the extent that he could not walk. His-total bilirubin level was 9.30 mg/dL. Enhanced liver phase 3 dynamic computed tomography confirmed extrahepatic biliary obstruction by an intraluminal common bile duct (CBD) mass (marked with a dotted line) with TACE-treated HCC (arrowhead) in the liver (Fig. 1A). On the 23rd day of hospitalization, his liver function further deteriorated that hepatic encephalopathy was developed, and the patient eventually received living donor liver transplantation. Explant showed cirrhotic configuration with CBD obstructed with reddish and bulging intraluminal mass (Fig. 1B).
      Fig 1
      Fig. 1(A) CT abdomen showing extrahepatic biliary obstruction by an intraluminal CBD mass (dotted line) with TACE-treated HCC (arrowhead) in the liver. (B) Explant showing cirrhotic configuration with CBD obstructed with reddish and bulging intraluminal mass. (C, D) Microscopic fundings showing stacked oval-to-spindle-shaped cells with eosinophilic cytoplasm (C) and desmin- and MyoD1-expressing cancer cells (D), suggesting rhabdomyosarcoma.
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