간세포암 환자에서 경동맥화학색전술 후 종양혈전의 이동에 의해 합병된 급성 폐쇄성 담관염: 증례보고 및 문헌고찰

• Published in: The Korean journal of gastroenterology Vol. 63; no. 3; pp. 171 - 175
• Main Authors: 박형철, Hyung Chul Park, 박현범, Hyun Bum Park, 정조윤, Cho Yun Chung, 정민우, Min Woo Jung, 주영은, Young Eun Joo, 최성규, Sung Kyu Choi, 조성범, Sung Bum Cho
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 30.03.2014
• Subjects: Bile duct; Biliary obstruction; Chemoembolization; Hepatocellular carcinoma; Migration
• ISSN: 1598-9992

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.