Cholangiocarcinoma

Case contributed by Dr Ian Bickle

Presentation

Short history of weight loss and anorexia. Clinically jaundiced. Bilirubin 166. GGT 1919. C19-9 4472 U/mL Cause?

Patient Data

Age: 74
Gender: Male
MRI

MRI LIVER

Severe diffuse intrahepatic duct dilatation down to the porta hepatis, with an abrupt cut off with a common hepatic and bile duct of normal calibre.

Approximately 6cm ill defined mass in segment 4a/b extending to the porta, at the site of the aforementioned cut-off.

No synchronous hepatic lesions.

Gallbladder packed with stones.  Normal wall thickness.

The remainder of the solid organs are normal.

No portal nodes.

CT

CT performed as part of staging study

CT ABDOMEN

CBD stent is in situ, extending into right hepatic duct.

Moderate dilatation of intrahepatic biliary ducts in the left hepatic lobe. 

Ill defined mass measuring 4.3 x 5.4 cm in segment 4.

Small volume periportal lymph nodes, measuring upto 8mm.

No significant para-aortic lymphadenopathy. No ascites.

The gallbladder is distended and contains stones.

Spleen, pancreas, both kidneys and adrenals are unremarkable.

Brushings performed at ERCP during the biliary stenting procedure confirmed a cholangiocarcinoma.

Case Discussion

This patient presented with severe jaundice for which an MRCP was performed after ultrasound identified biliary obstruction.

On MRCP the CBD is of normal calibre despite severe intrahepatic duct dilatation, therefore the site of obstruction was at the porta.   The ill defined intrahepatic mass in this context was strongly suggestive for a cholangiocarcinoma (Klatskin tumour), which was subsequently proven on histology.

Cholangiocarcinoma is a highly malignant tumour arising from cholangiocytes in the biliary tree, with a poor prognosis.

 

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Case information

rID: 49009
Case created: 5th Nov 2016
Last edited: 12th Dec 2016
Inclusion in quiz mode: Included

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