Bile Duct Lithiasis Mimicking a Perihilar Cholangiocarcinoma-An Endless Dilemma: A Case Report
Hilar bile duct strictures are mostly caused by malignant lesions. The morphological appearance of perihilar cholangiocarcinomas in various imaging modalities have other malignant and even benign mimics, which pose challenges to an accurate diagnosis and treatment and drive to futile surgery. Herein...
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Veröffentlicht in: | Journal of clinical medicine 2023-08, Vol.12 (15), p.5104 |
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creator | Piccino, Marco Hoxhaj, Ilda Grossi, Ugo Romano, Maurizio Brizzolari, Marco Scopelliti, Michele Finotti, Michele Zanus, Giacomo |
description | Hilar bile duct strictures are mostly caused by malignant lesions. The morphological appearance of perihilar cholangiocarcinomas in various imaging modalities have other malignant and even benign mimics, which pose challenges to an accurate diagnosis and treatment and drive to futile surgery. Herein, we present the case of a 50-year-old woman admitted with jaundice and abdominal pain, elevated bilirubin level, liver function tests and carbohydrate antigen 19-9 level. Magnetic resonance cholangio-pancreatography (MR-CP) and the computed tomography with contrast enhancement revealed a suspected extrahepatic cholangiocarcinoma of the common bile duct. Further spontaneous resolution of the scenario, confirmed by diagnostic assessment, changed the clinical hypothesis in favor of a non-oncological disease. Indeed, the multidisciplinary evaluation supported a diagnosis of transient cholangitis secondary to non-evident intrahepatic lithiasis rather than cholangiocarcinoma. After a 26-month follow-up, the patient was asymptomatic with normal tumor markers and laboratory data. Consecutive MR-CPs showed no suspicion of malignancy. This case report underlines the need for an accurate preoperative assessment in patients with suspected cholangiocarcinoma. |
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The morphological appearance of perihilar cholangiocarcinomas in various imaging modalities have other malignant and even benign mimics, which pose challenges to an accurate diagnosis and treatment and drive to futile surgery. Herein, we present the case of a 50-year-old woman admitted with jaundice and abdominal pain, elevated bilirubin level, liver function tests and carbohydrate antigen 19-9 level. Magnetic resonance cholangio-pancreatography (MR-CP) and the computed tomography with contrast enhancement revealed a suspected extrahepatic cholangiocarcinoma of the common bile duct. Further spontaneous resolution of the scenario, confirmed by diagnostic assessment, changed the clinical hypothesis in favor of a non-oncological disease. Indeed, the multidisciplinary evaluation supported a diagnosis of transient cholangitis secondary to non-evident intrahepatic lithiasis rather than cholangiocarcinoma. After a 26-month follow-up, the patient was asymptomatic with normal tumor markers and laboratory data. Consecutive MR-CPs showed no suspicion of malignancy. This case report underlines the need for an accurate preoperative assessment in patients with suspected cholangiocarcinoma.</description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm12155104</identifier><identifier>PMID: 37568507</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Abdomen ; Analysis ; Anticoagulants ; Antigens ; Bile ducts ; Biomarkers ; Blood tests ; Case Report ; Case reports ; Cholangiocarcinoma ; Cholangitis ; Clinical medicine ; Complications and side effects ; CT imaging ; Enzymes ; Gallstones ; Hepatectomy ; Leukocytes ; Liver ; Metastasis ; Pancreatitis ; Patients ; Thrombosis ; Ultrasonic imaging ; Veins & arteries</subject><ispartof>Journal of clinical medicine, 2023-08, Vol.12 (15), p.5104</ispartof><rights>COPYRIGHT 2023 MDPI AG</rights><rights>2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 by the authors. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c402t-316d3566ab58dafdd9c7f18e08b1bc73c74e42aac852a219dd6b892360afef9a3</cites><orcidid>0000-0001-7086-2456 ; 0000-0002-2902-5143 ; 0000-0001-5489-3009 ; 0000-0003-3101-7588 ; 0000-0002-7055-7117 ; 0000-0001-5372-2873 ; 0000-0001-9965-1281</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10420143/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10420143/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37568507$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Piccino, Marco</creatorcontrib><creatorcontrib>Hoxhaj, Ilda</creatorcontrib><creatorcontrib>Grossi, Ugo</creatorcontrib><creatorcontrib>Romano, Maurizio</creatorcontrib><creatorcontrib>Brizzolari, Marco</creatorcontrib><creatorcontrib>Scopelliti, Michele</creatorcontrib><creatorcontrib>Finotti, Michele</creatorcontrib><creatorcontrib>Zanus, Giacomo</creatorcontrib><title>Bile Duct Lithiasis Mimicking a Perihilar Cholangiocarcinoma-An Endless Dilemma: A Case Report</title><title>Journal of clinical medicine</title><addtitle>J Clin Med</addtitle><description>Hilar bile duct strictures are mostly caused by malignant lesions. The morphological appearance of perihilar cholangiocarcinomas in various imaging modalities have other malignant and even benign mimics, which pose challenges to an accurate diagnosis and treatment and drive to futile surgery. Herein, we present the case of a 50-year-old woman admitted with jaundice and abdominal pain, elevated bilirubin level, liver function tests and carbohydrate antigen 19-9 level. Magnetic resonance cholangio-pancreatography (MR-CP) and the computed tomography with contrast enhancement revealed a suspected extrahepatic cholangiocarcinoma of the common bile duct. Further spontaneous resolution of the scenario, confirmed by diagnostic assessment, changed the clinical hypothesis in favor of a non-oncological disease. Indeed, the multidisciplinary evaluation supported a diagnosis of transient cholangitis secondary to non-evident intrahepatic lithiasis rather than cholangiocarcinoma. After a 26-month follow-up, the patient was asymptomatic with normal tumor markers and laboratory data. Consecutive MR-CPs showed no suspicion of malignancy. This case report underlines the need for an accurate preoperative assessment in patients with suspected cholangiocarcinoma.</description><subject>Abdomen</subject><subject>Analysis</subject><subject>Anticoagulants</subject><subject>Antigens</subject><subject>Bile ducts</subject><subject>Biomarkers</subject><subject>Blood tests</subject><subject>Case Report</subject><subject>Case reports</subject><subject>Cholangiocarcinoma</subject><subject>Cholangitis</subject><subject>Clinical medicine</subject><subject>Complications and side effects</subject><subject>CT imaging</subject><subject>Enzymes</subject><subject>Gallstones</subject><subject>Hepatectomy</subject><subject>Leukocytes</subject><subject>Liver</subject><subject>Metastasis</subject><subject>Pancreatitis</subject><subject>Patients</subject><subject>Thrombosis</subject><subject>Ultrasonic imaging</subject><subject>Veins & arteries</subject><issn>2077-0383</issn><issn>2077-0383</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNptkdtLHDEUxoNUqlif-i6BPpaxuUwmmb6U7WovsGIp-mo4k2R2s51Jtsms4H_fiJeuYM5DAuc7P06-D6H3lJxy3pJPazNSRoWgpN5Dh4xIWRGu-Jud9wE6znlNylGqZlS-RQdcikYJIg_RzVc_OHy2NRNe-GnlIfuML_zozR8flhjwL5f8yg-Q8HwVBwhLHw0k40McoZoFfB7s4HLGZ4UzjvAZz_AcssO_3Sam6R3a72HI7vjxPkLX386v5j-qxeX3n_PZojI1YVPFaWO5aBrohLLQW9sa2VPliOpoZyQ3snY1AzBKMGC0tbbpVMt4Q6B3fQv8CH154G623eiscWFKMOhN8iOkOx3B65ed4Fd6GW918Y0RWvNC-PBISPHv1uVJr-M2hbK0ZqpuCRVckP-qJQxO-9DHQjOjz0bPZEMEbVh7rzp9RVXKumJsDK4vZr0c-PgwYFLMObn-eXNK9H3Oeifnoj7Z_eyz9ilV_g87HaHh</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Piccino, Marco</creator><creator>Hoxhaj, Ilda</creator><creator>Grossi, Ugo</creator><creator>Romano, Maurizio</creator><creator>Brizzolari, Marco</creator><creator>Scopelliti, Michele</creator><creator>Finotti, Michele</creator><creator>Zanus, Giacomo</creator><general>MDPI AG</general><general>MDPI</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7086-2456</orcidid><orcidid>https://orcid.org/0000-0002-2902-5143</orcidid><orcidid>https://orcid.org/0000-0001-5489-3009</orcidid><orcidid>https://orcid.org/0000-0003-3101-7588</orcidid><orcidid>https://orcid.org/0000-0002-7055-7117</orcidid><orcidid>https://orcid.org/0000-0001-5372-2873</orcidid><orcidid>https://orcid.org/0000-0001-9965-1281</orcidid></search><sort><creationdate>20230801</creationdate><title>Bile Duct Lithiasis Mimicking a Perihilar Cholangiocarcinoma-An Endless Dilemma: A Case Report</title><author>Piccino, Marco ; 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subjects | Abdomen Analysis Anticoagulants Antigens Bile ducts Biomarkers Blood tests Case Report Case reports Cholangiocarcinoma Cholangitis Clinical medicine Complications and side effects CT imaging Enzymes Gallstones Hepatectomy Leukocytes Liver Metastasis Pancreatitis Patients Thrombosis Ultrasonic imaging Veins & arteries |
title | Bile Duct Lithiasis Mimicking a Perihilar Cholangiocarcinoma-An Endless Dilemma: A Case Report |
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