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Clinicopathological Conference

Clinicopathological Conference. CPC #1 September 8, 2009. Patient. 62 year old male DM II COPD Chronic Hepatitis B with mild fibrosis U/S 4 months ago no mass HTN Active Smoker. HPI. 4 weeks fatigue 10/10 RUQ pain – radiated to the back Jaundice Light/clay colored stools Nausea

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Clinicopathological Conference

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  1. Clinicopathological Conference CPC #1 September 8, 2009

  2. Patient • 62 year old male • DM II • COPD • Chronic Hepatitis B with mild fibrosis • U/S 4 months ago no mass • HTN • Active Smoker

  3. HPI • 4 weeks fatigue • 10/10 RUQ pain – radiated to the back • Jaundice • Light/clay colored stools • Nausea • Dark urine

  4. At Risk • Hepatoma (3-4% risk per year) – Hepatitis B • Severe Infection – DM, COPD and Cirrhosis • FHF with appropriate trigger • Cancer risk – prostate, colorectal, lung

  5. Extrahepatic • Malignant • Cholangiocarcinoma • Pancreatic cancer • Gallbladder cancer • Ampullary cancer • Malignant involvement of the portahepatis lymph nodes • Hepatoma • Benign • Choledocholithiasis • Primary sclerosingcholangitis • Chronic pancreatitis • AIDS cholangiopathy • Stricture (benign)

  6. Differential Diagnosis • Hepatocellular Carcinoma • Correct Host • Fibrolamellar variant (nl AFP) • Pulmonary lesions • Cholangiocarcinoma • Ductal dilatation • Elevated CA 19-9

  7. Key points • Non-enhancing lesion on CT scan • Normal ultrasound 4 months ago • Normal AFP

  8. Cholangiocarcinoma • Adnocarcinoma of the epithelial cells of the biliary tract • 2-3,000 cases per year • Associated with primary sclerosing choangitis and chronic inflammation • Risk factors – parasitic liver infection (liver flukes) • Congenital liver abnormalities

  9. Diagnosis • Metastatic cholangiocarcinoma triggering fulminant hepatic failure in a patient with ETOH/Hep B cirrhosis

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