Female patient 31yo, loss of weight, RUQ and epigastric pain for some months with unknown cause of dilatation of intra-extrahepatic biliary tree.
At Medic Center, ultrasound shows a distention of gall bladder #132x62 mm without stone and some 10 - 17mm no vascular sign polyps. Furthermore there was a # 10 mm dilated common bile duct without stone downward to pancreas head.
Intrahepatic biliary tree dilated slightly without stone.
MRCP performed and detected CBD in dilatation then
collapsed near pancreatic head. Intra and
extrahepatic biliary tree dilated.
Gallbladder wall irregular thickening with mass # 17mm. Nodes exist around pancreatic head.
Uncinate processus of pancreas head has high
signal of contrast capture in T2FS. No dilatation of pancreatic duct. Radiologist thought about terminal part of CBD tumor invades uncinate processus of pancreas head.
Pancreaticoduodenectomy operation of Whipple
removed duodenopancreatic bloc.
Histopathologic results are 1/ poor differentiated
adenocarcinoma of CBD invades duodenum,
pancreas and nerves and
2/ poor differentiated adenocarcinoma of gallbladder invades peritoneal epithelium and vessels. Somes metastatic lymph nodes 4/4 and 6/7 nodes.
CONCLUSION= A rare case of multiple cholangiocarcinoma because it exists in young 31 yo female patient
[usually in 50 yo or over patient]
metastazing to pancreas, lymph nodes, nerves and vessels. Limits of technics of ultrasound makes ultrasound not reliable to find out cause of biliary duct obstruction and pancreas lesion than MRCP with contrast. Maybe elastography ultrasound and endoscopic ultrasound could detect more but unfortunately that not in use in this interesting case.
