Obstructive jaundice as the initial manifestation of hepatocellular carcinoma in a patient with previously unknown chronic hepatitis B infection: a case report and literature review

Joaquin Blanco; Luis D. Gonzalez; Abigail Cortes; Nidia Jimenez; Mario R. Pavia; María X. Gutierrez

doi:10.18203/2320-6012.ijrms20244137

Authors

Joaquin Blanco Department of Internal Medicine. Clínica Hospital Mérida, ISSSTE. Facultad de Medicina, Universidad Autónoma de Yucatán (UADY), Mérida, Yucatán, México
Luis D. Gonzalez Department of Internal Medicine. Clínica Hospital Mérida, ISSSTE. Facultad de Medicina, Universidad Autónoma de Yucatán (UADY), Mérida, Yucatán, México
Abigail Cortes Department of Internal Medicine. Clínica Hospital Mérida, ISSSTE. Universidad Nacional Autónoma de México
Nidia Jimenez Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
Mario R. Pavia Department of Internal Medicine. Clínica Hospital Mérida, ISSSTE. Facultad de Medicina, Universidad Autónoma de Yucatán (UADY), Mérida, Yucatán, México
María X. Gutierrez Department of Radiology. Clínica Hospital Mérida, ISSSTE. Facultad de Medicina, Universidad Autónoma de Yucatán (UADY), Mérida, Yucatán, México

DOI:

https://doi.org/10.18203/2320-6012.ijrms20244137

Keywords:

Hepatocellular carcinoma, Hepatitis B, Obstructive jaundice

Abstract

Hepatocellular carcinoma (HCC) is the most common liver neoplasm, accounting for 90% of cases, with hepatitis B and C infections being the main risk factors for its development. Diagnosis is primarily based on imaging studies, serology, and histology. Clinically, it presents with right upper quadrant pain and B symptoms, with jaundice occurring in 19-40% of cases. However, the onset of obstructive jaundice as the initial symptom occurs in approximately 1-12% of cases. We present the case of a 65-year-old male with a recent diagnosis of diabetes mellitus, who presented with progressive jaundice, documenting suggestive imaging findings of hepatocellular carcinoma with portal involvement and a positive viral panel for hepatitis B. Pathology report confirmed a differentiated hepatocellular carcinoma.

Metrics

Metrics Loading ...

References

Samant H, Amiri HS, Zibari GB. Addressing the worldwide hepatocellular carcinoma: epidemiology, prevention, and management. J Gastrointest Oncol. 2021;12:2.

Villanueva A. Hepatocellular carcinoma. N Engl J Med. 2019;380:1450-62.

Llovet J, Kelley R, Villanueva A, Singal A, Pikarsky E, Roayaie S, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7(1):1-28.

Di Bisceglie AM. Epidemiology and clinical presentation of hepatocellular carcinoma. J Vasc Interv Radiol. 2002;13(9).

Qin LX, Tang ZY. Hepatocellular carcinoma with obstructive jaundice: diagnosis, treatment, and prognosis. World J Gastroenterol. 2003;9(3):385-91.

McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of hepatocellular carcinoma. Hepatology. 2021;73:4-13.

Toh MR, Wong EYT, Wong SH, Tian Ng A, Loo LH, Chow PKH. Global epidemiology and genetics of hepatocellular carcinoma. Gastroenterology. 2023;164(5):766-82.

Sun VCY, Sarna L. Symptom management in hepatocellular carcinoma. Clin J Oncol Nurs. 2008;12(5):759.

Singal AG, Llovet JM, Yarchoan M, Mehta N, Heimbach JK, Dawson LA, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78(6):1922-65.

Hanif H, Ali MJ, Susheela AT, Khan IW, Luna-Cuadros MA, Khan MM, et al. Update on the applications and limitations of alpha-fetoprotein for hepatocellular carcinoma. World J Gastroenterol. 2022;28(2):216.

Reig M, Forner A, Rimola J, Ferrer-Fàbrega J, Burrel M, Garcia-Criado Á, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022;76(3):681-93.

Brown ZJ, Tsilimigras DI, Ruff SM, Mohseni A, Kamel IR, Cloyd JM, et al. Management of hepatocellular carcinoma: a review. JAMA Surg. 2023;158(4):410-20.

Alawyia B, Constantinou C. Hepatocellular carcinoma: a narrative review on current knowledge and future prospects. Curr Treat Options Oncol. 2023;24(7):711-24.

Huang JF, Wang LY, Lin ZY. Incidence and clinical outcome of icteric type hepatocellular carcinoma. J Gastroenterol Hepatol. 2002;17(2):190-5.

Jiang W, Fu X, Wang G, Qi H, Chen Z, Gao F. Effect of biliary tract invasion with obstructive jaundice on the prognosis of patients with unresectable hepatocellular carcinoma. Acad Radiol. 2023;30(3):483-91.

Mesci A, Gurer S, Guzel G, Demirbakan K. Obstructive jaundice caused by hepatocellular carcinoma with bile duct tumor thrombi: a case report. Eurasian J Med. 2008;40(1):45.

Van Dinter TG, Schmidt JF, Tarnasky PR. Obstructive jaundice caused by intraductal hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2011;9(9).