Roundtable Roundup: February | Biliary Tract Cancer

Publication
Article
Peers & Perspectives in OncologyFebruary I, 2024
Pages: 58

In separate virtual live events, R. Kate Kelley, MD, with Daneng Li, MD, and Chih-Yi (Andy) Liao, MD, with Anjana Pillai, MD, discussed imaging and treatment for a patient with biliary tract cancer with event participants.

CASE SUMMARY

  • A 72-year-old man presented to a local hospital with a 4-month history of jaundice, dark urine, itchy skin, and unintentional weight loss of 8 lb.
  • He was referred to a gastrointestinal specialist 2 months ago by his primary care physician but had no resolution of symptoms.
  • Physical examination showed an obese, tired-appearing man.
  • His medical history was unremarkable aside from a 20 pack-year history of smoking and relatively heavy alcohol consumption at approximately 15 drinks per week.
  • His laboratory results showed the following: Total bilirubin: 22.9 mg/dL
    • Direct bilirubin: 19.2 mg/dL
    • Alkaline phosphatase: 89 U/L
    • Alanine aminotransferase: 89 U/L
    • Aspartate aminotransferase: 99 U/L
    • γ-glutamyl transpeptidase: 222 U/L
    • Cancer antigen 19-9: 293 U/mL
    • Carcinoembryonic antigen: 10 ng/mL
    • α-fetoprotein: 20 ng/mL
  • Hepatitis B screening and autoimmune profile were negative.
Poll 1
poll 1. Liao, Pillai

CASE UPDATE

  • The patient underwent endoscopic retrograde cholangiopancreatography with brush cytology.
  • Bile duct strictures were visualized during the procedure.
  • Pathologic diagnosis:
    • Atypical tumor cells with enlarged nuclei and prominent nucleoli
    • Abundant stromal component with a desmoplastic reaction
    • Moderately differentiated infiltrative glands arising from a biliary intraepithelial neoplasia at the site of the choledocus, consistent with extrahepatic cholangiocarcinoma
  • Three weeks after surgery:
    • Total bilirubin: 1.2 mg/dL
    • Direct bilirubin: 0.2 mg/dL
  • A CT scan demonstrated multiple liver lesions plus extrahepatic perihilar regional lymph nodes and lesions in the left lung and left femur.


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