Intraductal Hepatocellular Carcinoma Leading to Obstructive Jaundice

A 48-year-old man with metabolic-dysfunction associated fatty liver cirrhosis was first on the transplant waitlist. Upon hospital admission, he complained of jaundice over the past month. Laboratory: total bilirubin 31.6 mg/dL (normal range <1.2); direct bilirubin 25.7 mg/dL (<0.2); alkaline phosphatase 200 U/L (<104); international normalized ratio 1.64 (<1.25). Serum alpha-fetoprotein was normal and all cultures were negative. Both ultrasound, tomography and magnetic resonance cholangiography (Figure 1) showed a biliary dilation of the right hepatic lobe, with no evidence of an obstructive factor. He had a normal enhanced tomography for hepatocellular carcinoma (HCC) surveillance (because of obesity) two months before. With no signs of infection, a transplantation was performed.