A special recurrent pattern in small hepatocellular carcinoma after treatment: Bile duct tumor thrombus formation

Figure 1 Small hepatocellular carcinoma in a 35-year-old male. A: T1-weighted magnetic resonance imaging (MRI) shows primary sHCC (arrow) in segment VIII; B: T2-weighted MRI shows an intrahepatic recurrent tumor (arrow) at the margin of the residual cavity following resection of primary sHCC; C: A BDTT (arrows) extending through the intrahepatic bile duct into the common bile duct is depicted in a T2-weighted image; D: Histologically, intrahepatic recurrent tumor and BDTT are moderately differentiated HCC [hematoxylin and eosin (HE), × 100]. sHCC: Small hepatocellular carcinoma; BDTT: Bile duct tumor thrombus; HCC: Hepatocellular carcinoma.

Figure 2 Small hepatocellular carcinoma in a 57-year-old male. A: Computed tomography (CT) shows primary sHCC (arrow) in segment V at the hepatic arterial phase; B: Forty-seven months after the initial operation, CT reveals a BDTT (arrows) with characteristics of early enhancement at the hepatic arterial phase; C: Tumor thrombus (arrows) extending through the common hepatic duct into the common bile duct is demonstrated during PTCD; D: Cancer nest invasion into the bile duct wall is observed histologically (HE, × 100). sHCC: Small hepatocellular carcinoma; BDTT: Bile duct tumor thrombus; HE: Hematoxylin and eosin; PTCD: Percutaneous transhepatic cholangial drainage.

Figure 3 Small hepatocellular carcinoma in a 41-year-old male. A: T1-weighted MRI shows primary sHCC (arrow) in segment VI; B: A BDTT (arrows) in the right intrahepatic bile duct and the common bile duct is noted on contrast-enhanced T1-weighted MRI; C: Filling defect (arrows) in the biliary tree is depicted during percutaneous transhepatic cholangial drainage. MRI: Magnetic resonance imaging; sHCC: Small hepatocellular carcinoma; BDTT: Bile duct tumor thrombus.