A special recurrent pattern in small hepatocellular carcinoma after treatment: Bile duct tumor thrombus formation

Table 1 Clinicopathologic characteristics of six cases of small hepatocellular carcinoma at the initial diagnosis

	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6
Sex/age (yr)	M/35	M/57	M/45	M/50	M/38	M/41
Chief complaint	Epigastric pain	Asymptomatic	Asymptomatic	Epigastric pain	Asymptomatic	Epigastric pain
HBsAg/HCV-Ab	+/-	+/-	+/-	+/-	+/-	-/-
Liver cirrhosis	+	+	+	+	+	-
AFP (ng/mL)	203.5	25	283	226.1	578.3	725.3
sHCC location/size	VIII/2.7 cm	V/2.0 cm	VI/1.5 cm	IV/2.0 cm	V/1.6 cm	VI/2.6 cm
Treatment	Partial segments V and VIII resection	Partial segment V resection	RF	Left lobectomy	Partial segment V resection	Segments VI and VII resection
Resection state	R1	R1	Ablative margin less than 5 mm	R1	R1	R1
Histologic differentiation	Moderate	Moderate	Moderate	Poor	Poor	Poor
Vascular infiltration	-	-		-	-	+
Tumor microsatellites	-	-		-	-	-
Bile duct or canaliculus invasion	-	-		-	-	-
Capsule presence	-	+		+	+	-

+: Positive; -: Negative. sHCC: Small hepatocellular carcinoma; HBsAg: Hepatitis B surface antigen; HCV-Ab: Hepatitis C antibody.

Table 2 Summary of clinical characteristics of bile duct tumor thrombus occurrence after treatment of small hepatocellular carcinoma

	Case 1	Case 2	Case 3	Case 4	Case 5	Case 6
Interval1	6 mo	47 mo	76 mo	5 mo	8 mo	9 mo
Chief complaint	Jaundice	Jaundice	Jaundice	Jaundice and epigastric pain	Jaundice	Jaundice
TBil/DBil (μmol/L)	47.1/28.8	365.0/283.3	286.0/206.5	35.7/27.3	146.0/87.2	480.0/360.3
AFP (ng/mL)	1.3	223.5	6.7	251.6	148.5	546
Recurrent tumor location/size	VIII/2.0 cm	-	VI/3.2 cm	V, VIII/5.2 cm	VI/2.8 cm	-
BDTT location	RIHBD-CBD	CHD-CBD	RIHBD-CBD	RHD-CBD	RIHBD-CBD	RIHBD-CBD
Treatment	Hepatic resection and BDTT removal	BDTT removal	Hepatic resection and BDTT removal	Hepatic resection and BDTT removal	Hepatic resection and BDTT removal	PTCD and TACE
Resection state	R1		R1	R1	R0
Histologic differentiation	Moderate	Poor	Poor	Poor	Poor
Vascular infiltration	-		+	+	+
Microsatellites	-		+	+	-
Capsule presence	-		-	-	-
Survival/prognosis	13 mo/dead	4 mo/dead	19 mo/dead	14 mo/dead	10 mo/dead	6 mo/dead

¹Interval between BDTT occurrence and initial treatment. AFP: Alpha-fetoprotein; TBil: Total bilirubin; DBil: Direct bilirubin; RIHBD: Right intrahepatic bile duct; CHD: Common hepatic duct; CBD: Common bile duct; RHD: Right hepatic duct; +: Positive; -: Negative; BDTT: Bile duct tumor thrombus.