n South African Gastroenterology Review - Distinguishing hepatocellular carcinoma from cholangiocarcinoma in a patient with haemobilia and cholangitis : case report

Volume 12, Issue 3
  • ISSN : 1812-1659



Historically, the distinction between hepatocellular carcinoma (HCC) and cholangiocarcinoma has been difficult for clinicians. Durand-Fardel first described a liver cancer that originated from the bile duct and not the parenchyma in 1840. The turning point had occurred in 1911 when histology differentiated HCC from cholangiocarcinoma. The American Association for the Study of Liver Disease (AASLD) guidelines recommends that the diagnosis of HCC can be confidently made in patients at risk by classical CT findings with alpha fetoprotein (AFP) playing a minor supporting role. Liver biopsy is thus not routinely performed for diagnosis. Furthermore, apart from the usual risks clinicians are reluctant to perform percutaneous liver biopsy of liver mass lesions due to concerns regarding needle tract seeding of malignant cells. Herein we present a case of a young retroviral positive patient with multiple liver mass lesions complicated by cholangitis and haemobilia. The value and limitations of AFP and the classic hepatic bruit in diagnosing HCC are briefly reviewed. In addition we look at the evidence supporting occult hepatitis B virus (HBV) as a risk for HCC.

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