Icteric Intraductal Hepatocellular Carcinoma and Bile Duct Thrombus Masquerading as Hilar Cholangiocarcinoma.

Dear Editor, Obstructive jaundice is a rare presenting clinical feature in patients with hepatocellular carcinoma (HCC). Icteric HCC is otherwise known as icteric-type hepatoma.1 It is known that intraluminal biliary obstruction may occur by one of 3 mechanisms: haemobilia caused by bleeding from the tumour, migration of tumour debris that has separated from the primary growth, or continuous retrograde tumour growth along the biliary tree. Although, HCC with bile duct thrombus (BDT) was historically associated with a poorer prognosis, some studies have shown that adequate surgical resection can still provide suffi cient palliation and occasional cure.2,3 In the past decade, several groups have reported their experience of HCC with BDT and most of these reports described patients with a signifi cantly sized parenchymal lesion.4,5 However, a subtype of intraductal hepatocellular carcinoma (IHCC) with BDT without an obvious parenchymal lesion is rarely reported as these predominantly intraductal lesions are often preoperatively misdiagnosed as cholangiocarcinoma.6-8 In this report, we present a series of 4 patients with icteric IHCC with BDT without apparent parenchymal lesion. We discuss the clinico-pathological characteristics of this unique subtype of IHCC with BDT and describe the surgical approach to these lesions.