An unusual case of jaundice: Biliary tumor thrombus in fibrolamellar hepatocellular carcinoma

BACKGROUND: Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare and unique variant of hepatocellular carcinoma (HCC) whose presentation remains inadequately described. We present a resectable case of FL-HCC which involved tumor thrombus of the common bile duct. PRESENTATION: A 27 year-old male presenting with jaundice, abdominal pain, vomiting, hepatic dysfunction and hyperbilirubinemia was found to have a large liver mass and lymphadenopathy on preoperative imaging. A right hepatectomy with perihepatic lymph node dissection and cholecystectomy was performed. Intraoperative cholangiogram demonstrated common bile duct (CBD) obstruction. CBD exploration revealed biliary tumor thrombus relieved with biliary thrombectomy. DISCUSSION: FL-HCC can initially present with invading obstructing biliary tumor thrombus of the CBD causing jaundice. CONCLUSION: Preoperative surgical approach should consider CBD exploration on an individual basis for underlying obstructive biliary tumor thrombus.