Hepatocellular carcinoma with tumor thrombus in bile duct: A proposal of new classification according to resectability of primary lesion

ARTICLE HIGHLIGHTS

Research background

Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is easily misdiagnosed or mistreated due to the clinicopathological diversity of the thrombus and its relationship with primary lesions.

Research motivation

To date, most of the published papers regarding HCC with BDTT have focused on its surgical procedures, but very few have discussed the relationships between the primary tumors and thrombus from the etiological and pathological perspective, which might be more critical for the diagnosis and treatment.

Research objectives

In the present retrospective study, we reviewed and analyzed our diagnosis and treatment experience regarding seven HCC patients with BDTT, including misdiagnosed cases. We also propose a new classification for HCC with BDTT based on its clinicopathological features.

Research methods

A retrospective review of the diagnosis and treatment experience regarding seven typical HCC patients with BDTT between January 2010 and December 2019 was conducted.

Research results

BDTT was preoperatively confirmed by computed tomography/magnetic resonance imaging in only four patients. Three patients with recurrent HCC and one patient with first-occurring HCC had no visible intrahepatic tumors; of these, misdiagnosis occurred in two patients, and three patients died. One patient was mistreated as having common bile duct stones, and another patient with a history of multiple recurrent HCC was misdiagnosed until obvious biliary dilation could be detected. Only one patient who received hepatectomy accompanied by BDTT extraction exhibited disease-free survival during the follow-up period. A new classification was proposed for HCC with BDTT as follows: HCC with microscopic BDTT (Type I); resectable primary or recurrent HCC mass in the liver with BDTT (Type II); BDTT without an obvious HCC mass in the liver (Type III); and BDTT accompanied with unresectable intra- or extrahepatic HCC lesions (Type IV).

Research conclusions

We herein propose a new classification system for HCC with BDTT to reflect its pathological characteristics and emphasize the significance of primary tumor resectability in its treatment.

Research perspectives

The classification system and its guiding significance in the treatment of HCC with BDTT.