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Complex diagnostic evaluation – A pictorial review of progression of Cholangiocarcinoma relapse
Poster Title: Complex diagnostic evaluation – A pictorial review of progression of Cholangiocarcinoma relapse
Submitted on 28 Aug 2019
Author(s): Dr Qurrat-ul-ain Tahir
Affiliations: East Suffolk and North Essex NHS Foundation Trust
Poster Views: 189
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Poster Information
Abstract: Title: Complex diagnostic evaluation – A pictorial review of progression of Cholangiocarcinoma relapse


Cholangiocarcinoma is a rare cancer account of approximately four to six cases per million populations. Patient usually presents with the obstructive jaundice. (1) Endoscopic Retrograde cholangiopancreatography (ERCP) and Endoscopic Ultrasonography (EUS) are the useful diagnostic modalities. (2) Here, we are presenting a pictorial review of an unusual presentation of Cholangiocarcinoma relapse after 5 months of previously radically treated cholangiocarcinoma, where the correlation between Ultrasonography (USG), CT scan, gastroscopy and EUS were used to establish the underlying cause and further management.

1. To report the unusual clinical presentation
2. To familiarize the characteristics appearance on imaging.

Clinical Presentation
70 years old lady presented to A&E with the symptoms of indigestion, vomiting and abdominal pain on background of recent radical resection of cholangiocarcinoma,(pT3 No Mo) which was an incidental finding after elected cholecystectomy She was started on adjuvant chemotherapy. At presentation, she was on 4th cycle of her chemotherapy. US Abdomen was performed initially. Contrast CT scan later on showed moderate gastric distension with the collapsed second duodenal segment along with the haziness and stranding of surrounding fat planes.
Conservative management initiated but patient deteriorated. Repeat CT scan at 10 days’ interval revealed worsening of gastric distension, more marked stranding around duodenum along with the progressive dilatation of intra-hepatic biliary radicles, CBD and pancreatic duct, hence suspecting cholangiocarcinoma. Therefore, EUS arranged and relapse of cholangiocarcinoma was confirmed. But delayed diagnosis led to palliative management of the patient with the possible duodenal stenting.

Learning points:
It has highlighted how multiple imaging modalities interpretation lead to establish morphological, structural and functional information. Therefore, helped to guide further management plan.

Dr Suat Loo, Consultant Oncologist ESNEFT

Dr Sandeep Kumar, Consultant Radiologist ESNEFT

Summary: Cholangiocarcinoma is rare carcinoma and presentation usually involves abdominal pain and jaundice.
In our case, patient presented with the features of gastric outlet obstruction 6 months after the initial radical management of primary cholangiocarcinoma. Therefore, both clinically and radiologically the diagnosis was challenging. Endoscopic Ultrasound thereafter helped to clarify the underlying cause of the progressive deterioration of the patient.
References: REFERENCES
Neoptolemos JP, Talbot IC, Carr-Locke DL, et al. Treatment and outcome in 52 consecutive cases. Br J Surg 1987; 74:957.

2. Skordilis P, Mouzas IA, Dimoulios PD, et al. Is endosonography an effective method for detection A prospective study. BMC Surg 2002; 2:1.

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