6. A Case of Ulcerative Colitis with Rare Complication of Cholangiocarcinoma

Background: In Ulcerative colitis (UC), primary sclerosing cholangitis (PSC) develops in approximately 2.4–7.5% of the patients and PSC is considered as an intermediate step in the development of cholangiocarcinoma (CC). Very few case reports and consensus on management are available regarding CC with PSC. Case Summary: 31 years old male presented with history of intermittent, dull aching right hypochondriac pain of eight months duration. He had history of increased frequency (6–8 times/day) and loose stools of three months duration. It was associated with generalized pruritus and weight loss. He is a case of ulcerative pancolitis (UC) on treatment [Tb Mesacol 1.2 gm (1-0-1)] with regular follow up for ten years duration. His blood investigations revealed anemia (Hb-10.7 gm/dl), thrombocytosis (9,40,000/cumm), raised ESR (85 mm/1st hour), raised CRP (26 mg/dl) and raised alkaline phosphatase (287 IU/L). Ultrasound showed dilated intrahepatic biliary radicles. MRCP showed features of multifocal strictures with multiple intrahepatic biliary ductal calculi in left lobe. Workup for biliary stricture with contrast enhanced computed tomography of abdomen revealed ill defined mass lesion (10.8 × 5.6 cm) involving liver segments (II, IIII, IVa and IVb) and abdominal lymphadenopathy. His tumour markers were as follows; CA19-9:2310 IU/L and CEA:65 ng/ml. He underwent ERCP guided biliary sphincterotomy and biliary stent placement. Brush cytology from biliary stricture was negative for malignancy. Considering possibility of cholangiocarcinoma with left lobe localization he was subjected for left hemihepatectomy. Intraoperatively atrophied left lobe of liver and beaded appearance of biliary tree was noted. Histopathology of the resected specimen showed features of well differentiated, Periductal infiltrating type of cholangiocarcinoma with sclerosing cholangitis (T1NxMx). Tumour cells expressed CK-7, CK-20, CK-19 and CA 19-9. On follow up his investigations were CA-19-9-26.77 U/ml and CEA-3.81 ng/ml. Conclusions: High suspicion and early intervention for cholangiocarcinioma in the presence of primary sclerosing cholangitis may improve the outcome. The authors have none to declare.