Early and small hepatocellular carcinoma (HCC) rarely presents with biliary ductal invasion. We present a case of early HCC presenting with biliary invasion, in the absence of a mass on computed tomographic scanning. The patient, a hepatitis B carrier, was initially diagnosed to have “liver fluke infection” after a “leaf-like structure” was found within the right hepatic duct on endoscopic retrograde cholangiopancreatography (ERCP). The specimen was retrieved with a Dormia basket. Histology revealed HCC. This report highlights an unusual case of early and small HCC presenting with biliary ductal invasion. A high index of suspicion has to be entertained in the background of hepatitis B regardless of the atypicity of presentation.
Hepatocellular carcinoma (HCC) is a common malignant tumour worldwide. The local incidence of HCC is 40 per 100,000 in males and 20 per 100,000 in females.
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