Diagnosis and Therapy of Ectopic Hepatocellular Carcinoma Growing in the Intrahepatic Bile Duct.

A 63-year male was admitted with abdominal pain, fever and jaundice. The contrast-enhanced computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiography showed a mass in the hepatic hilar region with dilation of the intrahepatic bile duct. The left branch of portal vein was also compressed by the mass. The patient was diagnosed as intrahepatic bile duct carcinoma and underwent the left hemihepatectomy together with right hepatic duct jejunum anastomosis (Roux-en-Y)combined with hepatoduodenal ligament lymphadenectomy. In the left intrahepatic bile duct, a mass of 3 x 2 x 2 cm was seen extending into the common hepatic bile duct. No tumor was detected in the liver parenchyma. The left portal vein compression by the tumor was confirmed during surgical exploration. Immunostaining showed hepatocyte(+), AFP(+/-), CK(+/-), which indicated that the cancerous tumor cells were derived from hepatocytes but not from bile duct epithelial cells. The final diagnosis of this patient was hepatocellular carcinoma growing in the intrahepatic bile duct.