HEPATOCELLULAR CARCINOMA HAVING UNUSUAL APPEARANCE OF TUMOR THROMBUS IN CBD ALONG WITH COINCIDENCE OF GALL BLADDER ASCARIASIS

Abstract

Hepatocellular carcinoma is the most common type of liver cancer. Liver cancer usually is caused by liver scarring or cirrhosis. Cirrhosis typically is caused by alcohol abuse, hepatitis, or autoimmune disease. People with hepatitis B or C may be at risk for hepatocellular carcinoma, even though they do not have cirrhosis. In Asia and Africa viral infection is most common cause whereas alcoholism being the most common cause of hepatic cirrhosis in USA and Europe leading to HCC. HCC is an aggressive tumor known for its propensity to directly invade the portal and hepatic veins, but lymphatic and distant metastases are not rare, especially in tumors greater than 5 cm [6]. Most extrahepatic HCC occurs in patients with an advanced intrahepatic tumor stage (stage IVa), as expected [5, 7]. The prognosis of patients with extrahepatic metastases is generally very poor. Ascariasis, the most common helminthic infection is caused by ascaris lumbricoides. Usually the adult worm lives in the small intestine. The migration of the parasite from small intestine into other organs is a very dangerous aspect of ascariasis. Rarely, it migrates through the papilla of vater and may enter the common bile duct. Presence of Ascaris lumbricoides in gallbladder is rare entity as it is difficult to reach their due to narrow and tortuous cystic duct. We are reporting a case of Hepatocellular carcinoma having direct infiltration into CBD presenting as tumor thrombus along with coincidence of GB ascariasis.