Hepatocellular carcinoma invading the fourth branch of the left intrahepatic duct - 22/08/11
Doi : 10.1016/j.gie.2006.06.053
Jung Il Lee, MD, Jin-Woo Lee, MD, Kye Sook Kwon, MD, Hyung Gil Kim, MD, Yong Woon Shin, MD, Young Soo Kim, MD
Division of Gastroenterology, Department of Internal Medicine
Don Haeng Lee, MD
Division of Gastroenterology, Department of Internal Medicine, and Center for Advanced Medical Education, Inha University College of Medicine, Inchon, South Korea
Lawrence J. Brandt, MD, Editor, At the Focal Point Section
| Commentary Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy; it largely results from hepatitis B and C infection, chronic aflatoxin ingestion, or alcohol abuse. Abdominal pain is the most common symptom and may be accompanied, as in this case, by fever in up to 54% of cases. Such a cholangitic picture, usually seen in malignancy only after the biliary tree has been manipulated, is more common with HCC than with metastatic disease to the liver. Cholangitis classically is characterized by Charcot’s triad, which comprises abdominal pain, fever, and jaundice, although jaundice is a late sign of HCC (Charcot described 2 triads; the other—nystagmus, tremor, and scanning speech—is seen in multiple sclerosis.). The absence of other symptoms is noteworthy, and patients from highly endemic regions (Asia, Africa) often are unaware of their disease until there is an acute or fulminant presentation (eg, hemoperitoneum), which typically may be delayed until the tumor has reached an advanced stage. In this patient, HCC was ultimately diagnosed because a biliary radical was obstructed with a chicken fat–like cast. The cast of characters in HCC that may obstruct a duct include tumor (whitish), blood (reddish brown), and sludge or stone, (brownish-blackish). We are making diagnoses such as HCC earlier and earlier, because of advances in technology, as the present case illustrates. Whether earlier diagnosis can be translated to better survival, however, is a highly individual scenario. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2007
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 65 - N° 6
P. 914-915 - mai 2007 Retour au numéro
Article précédent
- Iatrogenic colonic perforations: a threat turned into insignificance?
- Annette Fritscher-Ravens
- Papillary type of early common bile duct cancer
- Seok Jeong, Jung Il Lee, Jin-Woo Lee, Kye Sook Kwon, Hyung Gil Kim, Yong Woon Shin, Young Soo Kim, Don Haeng Lee, In Suh Park
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?