Fig 4 - available from: BMC Surgery
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a Contrast-enhanced CT scan revealed dilation of left intrahepatic bile duct (8 mm) and a high-density mass in segments II and III. b, c MRCP also revealed a 20 × 14 mm mass in segments II and III. d ERCP revealed a shadow defect in segments II and III. No other tumor or defect was detected
Source publication
Background:
Biliary metastasis of colorectal cancer is a manifestation of metastatic liver carcinoma, and is often difficult to differentiate from cholangiocarcinoma. Further, lower bile duct metastasis of colorectal cancer is rare. We report the case of a 74-year-old woman who underwent pylorus-preserving pancreatoduodenectomy for lower bile duct...
Context in source publication
Context 1
... years after undergoing hepatectomy, the followup CT scan revealed dilation of the left intrahepatic bile duct and a high-density mass in the common trunk of segment II and segment III (B23). Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) also revealed a mass in B23 (Fig. 4). The biopsy findings from ERCP confirmed adenocarcinoma. Therefore, she underwent left and caudal lobectomy with extrahepatic bile duct resection in April 2017. Histological examination revealed a moderately differentiated tubular adenocarcinoma in segments II and III that invaded into the left hepatic duct and the liver parenchyma, ...
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A 13-year-old girl developed intrahepatic cholangiocarcinoma 7 years after laparoscopic extrahepatic bile duct resection and biliary reconstruction to treat Todani's type IV-A congenital biliary dilatation (CBD). During the postoperative period, her serum carbohydrate antigen 19-9 levels were above normal, and the imaging tests showed intrahepatic...
Objectives
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Methods
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Purpose
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Methods
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Citations
... La mayoría de las metástasis de cáncer de colon son CK7− y CK20+, mientras que los tumores originados en el epitelio de la vía biliar suelen ser CK7+ y CK20− 11 . Una expresión CK7−/CK20 + tiene un valor predictivo positivo del 93% para metástasis de cáncer colorrectal 14 . Por otro lado, la proteína SATB2 es un marcador nuclear del tracto gastrointestinal inferior que aparece en el 85% de los casos de CCR, de modo que la positividad para SATB2 o CK20 diagnostica el 97% de los CCR. ...
... Existe algún caso descrito en la literatura en que se realizó una duodenopancreatectomía cefálica por afectación del colédoco distal 14 . ...
... En nuestra paciente no se administró QT neoadyuvante porque la sospecha inicial era de colangiocarcinoma y no de metástasis hepáticas de CCR. No obstante, no existe suficiente evidencia de que la QT adyuvante mejore el pronóstico de los pacientes 14 . En algunos estudios, como en el de Reijonen,et al. 4 , todos los pacientes fueron tratados con quimioterapia neoadyuvante y adyuvante, mientras que otros grupos optan por no administrar QT adyuvante 14 . ...
Introduction:
Intrabiliary growth of colorectal liver metastasis determines their capability of dissemination and relapse.
Case report:
65-year-old woman underwent sigmoidectomy (2011) and left hepatectomy due to liver metastases affecting the bile tract (2014). In 2020 she developed a 2cm tumour in the union of both hepatic ducts. Cholangiocarcinoma was suspected so resection of the main bile duct, the caudate lobe and lymphadenectomy were performed. On immunohistochemical examination, colorectal liver metastasis was confirmed.
Conclusions:
Liver metastases should be considered as the most likely diagnosis when bile duct dilatation or intrabiliary growth is seen in patients with a history of colorectal cancer.
Introduction and importance
Extrahepatic metastasis is an exceptional site for rectal adenocarcinoma. Its clinical and radiological presentations are similar to those of cholangiocarcinoma, and its management requires collaboration between surgeons, endoscopists, and oncologists.
Case presentation
We present a unique case of a 58-year-old woman previously treated two and a half years ago for middle rectal adenocarcinoma with liver metastasis. In the immediate postoperative period, following restoring digestive continuity, she presented cholestatic jaundice from malignant obstruction of the extrahepatic bile duct. A midline laparotomy revealed a tumor of the common bile duct invading the hepatic pedicle. Therefore, external bile drainage, biopsy and hepatic lymph node dissection were performed. Immunohistochemical staining confirmed the diagnosis of extrahepatic bile duct metastasis from rectal adenocarcinoma.
Clinical discussion
Extrahepatic bile duct metastasis from rectal adenocarcinoma manifests as bile duct stenosis or intraluminal lesions, and only pathological examination with immunochemical staining confirms the diagnosis. Radical treatment is possible when general conditions allow it.
Conclusion
Our case is the twelfth to describe a solitary metastasis of the bile duct metastasis from colorectal adenocarcinoma. The rarity of published cases in the literature means that their development mechanism and management are not well-codified.
Malignant biliary obstruction generally results from primary malignancies of the pancreatic head, bile duct, gallbladder, liver, and ampulla of Vater. Metastatic lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary obstruction. The most common primaries include renal cancer, lung cancer, gastric cancer, colorectal cancer, breast cancer, lymphoma, and melanoma. They may be difficult to differentiate from primary hepato-pancreato-biliary cancer based on imaging studies, or even on biopsy. There is also no consensus on the optimal method of treatment, including the feasibility and effectiveness of endoscopic intervention or surgery. A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is presented. The diagnostic modality and clinical characteristics may differ significantly depending on the type of primary cancer. Different primaries also cause malignant biliary obstruction in different ways, including direct invasion, pancreatic or biliary metastasis, hilar lymph node metastasis, liver metastasis, and peritoneal carcinomatosis. Metastasectomy may hold promise for some types of pancreato-biliary metastases. This review aims to elucidate the current knowledge in this area, which has received sparse attention in the past. The aging population, advances in diagnostic imaging, and improved treatment options may lead to an increase in these rare occurrences going forward.
