Abstract YO14
Case summary
Intrahepatic cholangiocarcinoma (ICC) is the 2nd most common primary liver cancer with higher probability of metastasis. Incidence varies due to different distribution of risk factors. Presentations may vary in patients hence most patients are seen at the advanced stage of the disease. Prognosis may be dictated by tumor factors. The aim of this study is to review the disease and related literatures with similar presentation for knowledge and awareness in clinical practice.
We report on a case of a 49 year old male, Filipino, with 2 month history of left shoulder pain and limitation in range of motion. Pain worsened involving the lower back and radiation to the left leg. A spine MRI showed abnormal bone marrow signals in the T11, T12, L2 to L4 vertebral bodies, bilateral sacral and left iliac wings. Seen in the FDG PET/CT scan are multiple hypermetabolic lytic lesions with soft tissue elements involving the axial and appendicular skeleton, multiple hypermetabolic hepatic nodules, thoracic and abdominal lymphadenopathies and focus in the distal esophagus. He had normal AFP, high CEA 312 ng/mL and CA 19-9 >100000.0 U/mL. Esophagogastroduodenoscopy with biopsy was performed with findings of a 1.5cm soft nodular lesion at the distal esophagus and a smaller nodular lesion along the gastroesophageal junction. The esophageal lesion biopsy results showed poorly differentiated adenocarcinoma of pancreaticobiliary origin with immunohistochemistry features: positive CK7, CK20, CK19, Ca 10-8, CDX2 and Her2/neu. MRI MRCP showed multiple fairly defined hypoenhancing masses showed cellular periphery with diffusion restriction and mild delayed phase enhancement largest in the left at segment 3 measuring 2.9 x 3.3 cm, and in the right at segment 8 measuring 3.9 x 2.5 cm. Well differentiated adenocarcinoma was seen in the liver nodule biopsy. He was diagnosed with metastatic intrahepatic cholangiocarcinoma and was advised to receive systemic treatment.
ICC carries a poor prognosis due to late diagnosis of the disease. Identifying risk factors is critical and early recognition of initial symptoms may result to better outcome. Serum tumor markers have value in the diagnosis and elevated values prior to treatment portend poor survival.
Clinical trial identification
Editorial acknowledgement
We acknowledge the contribution of Dr. Marina Tan, Dr. Hannah Lacar of the GI department, the pathology and radiology sections of The Medical City in the wiriting of this paper.