Semin Liver Dis 2004; 24(2): 209-213
DOI: 10.1055/s-2004-828897
DIAGNOSTIC PROBLEMS IN HEPATOLOGY

Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Invasive Colloid Carcinoma Arising from Intraductal Papillary Neoplasm in a 50-Year-Old Woman with Primary Sclerosing Cholangitis

Moueen Bu-Ghanim1 , Arief Suriawinata2 , Mary Killackey3 , Myron E. Schwartz3 , David Jaffe4 , M. Isabel Fiel1
  • 1The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Mount Sinai Medical Center, New York, New York
  • 2Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
  • 3The Recanati-Miller Transplantation Institute and the Department of Internal Medicine, Mount Sinai Medical Center, New York, New York
  • 4Department of Internal Medicine, Mount Sinai Medical Center, New York, New York
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
11. Juni 2004 (online)

Preview

CASE REPORT

A 50-year-old woman with primary sclerosing cholangitis (PSC) came to our institution for transplant evaluation. She was diagnosed with ulcerative colitis at the age of 24, at which time she also underwent cholecystectomy for significant biliary colic. She did well over the years and required only intermittent treatment for ulcerative colitis. Three years prior to presentation, an elevated serum alkaline phosphatase activity was noted in preoperative laboratory tests for a gynecological procedure. She was referred for endoscopic retrograde cholangiopancreatography (ERCP), which revealed irregular strictures and dilatation of the intrahepatic bile ducts with a beadlike appearance, consistent with PSC. Initial bile duct brushing cytology found atypical cells consistent with acute inflammation. Over the next 2 years, she complained of intermittent fevers and right upper quadrant pain, both of which resolved with levofloxacin, but a percutaneous biliary drain was eventually needed. Thereafter, she had multiple episodes of acute cholangitis, despite frequent biliary tube evaluations and changes.

The decision was made to begin liver transplant evaluation. The patient's Model for End-Stage Liver Disease (MELD) score was 6. The carbohydrate antigen (CA) 19-9 level was 335 U/mL (n = 0-35 U/mL). Computed tomography (CT) at that time revealed changes consistent with PSC with an additional atypical finding of dilated ducts in the posterior right lobe, but no mass was appreciated (Fig. [1]). Portal lymphadenopathy, similar in appearance to that seen in a previous study 1 year earlier, was noted on CT scan. She underwent repeat ERCP with brushings that again revealed atypical cells without evidence of dysplasia. Both the elevated CA 19-9 (now 595 U/mL) and the cytology results were considered consistent with the clinical picture of recurrent bacterial cholangitis. An appeal was approved for a higher MELD score on the basis of recurrent cholangitis; within 2 months a liver became available and she underwent orthotopic liver transplantation.

Figure 1 CT scan of the liver performed 6 months prior to transplantation showing cystic dilatation of bile ducts in the posterior right lobe (arrow).

REFERENCES

M. Isabel FielM.D. 

Mount Sinai School of Medicine, One Gustave L. Levy Place

New York, NY 10029

eMail: mariaisabel.fiel@msnyuhealth.org