A 64-year-old male patient was studied for pain in the right hypochondrium for a few weeks without other accompanying symptoms.
The analytical only highlighted a slightly elevated GGT (70 U/l) with an CA 19.9 of 170 U/ml.
The rest of the analytical parameters were normal.
Abdominal ultrasound showed dilation of the left bile duct, while the main and right bile ducts had normal characteristics.
A cholangio-MRI is performed in which a dilatation of the left biliary tree with a polypoid lesion in the origin of the left hepatic duct can be observed, without other findings.
Prior to treatment, ERCP was performed, demonstrating dilation of the left bile duct due to the existence of a polypoid lesion at the origin of the left hepatic duct, which was biopsied.
A plastic stent is also placed.
The biopsy confirmed the diagnosis of papillary neoplasia with high grade dysplasia.
Surgical treatment is proposed and cholecystectomy, anatomic left hepatectomy with segment I resection and excision of the left biliary tree to confluence with the right are performed.
Intraoperative examination of the biliary section edge showed no involvement.
The postoperative course was unremarkable.
The pathological study confirms the diagnosis of intraductal papillary biliary neoplasia with focus of papillary and invasive cholangiocarcinoma, without lymph involvement.
The resection margins were free.
Treatment is not performed after five years of follow-up.
