Occult hepatocellular carcinoma: a case report of a special icteric-type hepatoma and literature review.

Hepatocellular carcinoma (HCC) presenting with obstructive jaundice due to bile duct tumour thrombi is classified as icteric-type hepatoma. This report describes a case of unusual icteric-type HCC with common bile duct thrombus, which is herein named 'occult HCC', as no detectable primary lesion in liver was defined pre-operatively and intra-operatively. A thrombectomy followed by a T biliary drainage tube placement was carried out, and the final post-operative pathological evaluation demonstrated the tumour thrombus originated from a moderately differentiated HCC. The clinicopathological features and logical clinical interventions of this rare type of HCC were discussed with a review of the literature. The HCC patients with bile duct thrombi receiving palliative biliary drainage alone had a poor outcome. With respect to improving prognosis, a curative resection of primary HCC and tumour thrombi was suggested on the basis of performing an intensive post-operative monitoring for early detection of primary liver lesion.