A 78-year-old male was admitted to the emergency department for pain in the right hypochondrium accompanied by fever and cutaneous-mucosal subicterus.
Laboratory tests showed elevated GGT and mild total bilirubin with an CA 19.9 of 1,973 U/ml.
As in the first case, ultrasound shows dilation of the left bile duct.
In this case, a large dilatation of the left biliary tree with occupation of villous and mucinous material can be seen in the magnetic resonance cholangiography.
ERCP shows the mucin output and the villous occupation of the left biliary tree, from which a biopsy is taken, and a plastic stent is placed.
Histology shows intraductal papillary neoplasia with high grade dysplasia.
Surgical treatment is also proposed, performing left hepatectomy with resection of segment I and left biliary tree, cholecystectomy and lymphadenectomy of the hepatic hilium.
Intraoperative biopsy shows the absence of involvement of the biliary resection edge.
The definitive histological study confirms the diagnosis of cholangiocarcinoma with isolated microinfiltrating component and focal in distal branch of hepatic segment III with mucus production.
No adjuvant treatment was performed and the patient, after four years of follow-up, had no recurrence of the disease.
