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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Hepatocellular carcinoma with tumor thrombus in bile duct: A proposal of new classification according to resectability of primary lesion
Di Zhou, Gang-Feng Hu, Wei-Chen Gao, Xiao-Yu Zhang, Wen-Bin Guan, Jian-Dong Wang, Fei Ma
Di Zhou, Xiao-Yu Zhang, Jian-Dong Wang, Department of General Surgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China
Gang-Feng Hu, Wei-Chen Gao, Department of General Surgery, Xinhua Hospital Affiliated with Shanghai Jiao Tong University, School of Medicine, Chongming Branch, Shanghai 202150, China
Wen-Bin Guan, Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China
Fei Ma, Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China
Fei Ma, Shanghai Institute for Pediatric Research, Shanghai 200092, China
Author contributions: Zhou D and Hu GF designed and performed the research and wrote the paper; Guan WB contributed to the pathological analysis; Zhang XY and Wang JD performed the follow-up; Gao WC and Ma F designed the research and supervised the report.
Supported by the National Natural Science Foundation of China, No. 81802337; and Shanghai Jiao Tong University, No. YG2017MS74.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Xinhua Hospital Affiliated with Shanghai Jiao Tong University, School of Medicine.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/licenses/by-nc/4.0/ Corresponding author: Fei Ma, MD, Doctor, Department of Oncology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China. mafei@xinhuamed.com.cn
Received: May 5, 2020
Peer-review started: May 5, 2020
First decision: June 4, 2020
Revised: June 10, 2020
Accepted: September 22, 2020
Article in press: September 22, 2020
Published online: November 28, 2020
BACKGROUND
Hepatocellular carcinoma (HCC) with tumor thrombus in the bile duct (BDTT) is easily misdiagnosed or mistreated due to the clinicopathological diversity of the thrombus and its relationship with primary lesions.
AIM
To propose a new classification for HCC with BDTT in order to guide its diagnosis and treatment.
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.
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).
CONCLUSION
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.
Core Tip: Hepatocellular carcinoma with a tumor thrombus in the bile duct is easily misdiagnosed or mistreated. We herein review our diagnosis and treatment experiences and propose a new classification for this complicated disease based on its clinicopathological features.
