Gastrointestinal: Transmural colonic metastasis arising from primary cholangiocarcinoma

Abstract

Gastrointestinal: Transmural colonic metastasis arising from primary cholangiocarcinomaj gh_6396 1329A 59-year-old woman presented with a sudden onset of pain in the right upper abdomen. Laboratory findings demonstrated elevated hepatobiliary enzymes. Ultrasound imaging demonstrated calculi in the gallbladder (GB) and thickening of the GB wall. Calculous cholecystitis was diagnosed. A percutaneous cholecystostomy and tube drainage of the GB was performed, which relieved the patient of her symptoms. Cholangiography via the drain tube demonstrated narrowing of the common bile duct, and a cytological examination indicated adenocarcinoma. Because of intermittent hematochezia during the previous 2 months, a colonoscopy was performed and multiple depressed erythematous lesions and mucosal retraction were found in the proximal transverse and sigmoid colon (Figure 1). These lesions contributed to the hematochezia because the colonic lesion was friable and bled easily with scope contact. A histological examination of the biopsy revealed adenocarcinoma (Figure 2), which was negative for CDX-2 and cytokeratin (CK)-20 and positive for CK-7. FDG-PET revealed multiple spotty FDG uptake in the peritoneal cavity and FDG uptake along the extrahepatic bile duct. We diagnosed a colonic metastasis arising from the primary cholangiocarcinoma. CK-7 and -20 are the widely used immunohistochemical markers that support a diagnosis of adenocarcinoma. CK-20 is positive in approximately 70-95% of colorectal and 20-40% of pancreaticobiliary adenocarcinomas. CK-7 is positive in 90-100% of pancreaticobiliary and 5-25% of colorectal adenocarcinomas. The CK-7 negative/CK-20 positive phenotype is found in more than 90% of colonic adenocarcinomas and the CK-7 positive/CK 20 positive or CK-7 positive/ CK-20 negative phenotypes are found in one third and two thirds of pancreaticobiliary adenocarcinomas, respectively. CDX-2 is a highly sensitive and specific marker for gastrointestinal adenocarcinoma (98% specificity for gastric and colorectal adenocarcinomas). A metastatic carcinoma of the colon is rare in clinical practice and comprises about 1% of all carcinomas of the colon. Several previous reports have revealed gastric cancer as the most common primary carcinoma metastasis to the colon, comprising 20-60% of metastatic carcinomas of the colon, followed by the pancreas, ovary, and lung. Metastasis of primary cholangiocarcinoma to the colon is rare, and the appearance of the metastastic lesion has been rarely reported. The appearance reported here is consistent with cancer infiltration into the mucosa from the deeper layers.

Metastatic Cholangiocarcinoma Presenting as Colonic Obstruction

“…1 Metastatic spread to the colon is a seldom documented phenomenon, of which we located 10 published case reports. 2–12 Of these, only 2 feature malignant colonic obstruction. 10,13…”

“…1 Metastatic spread to the colon is a seldom documented phenomenon, of which we located 10 published case reports. [2][3][4][5][6][7][8][9][10][11][12] Of these, only 2 feature malignant colonic obstruction. 10,13 Literature describing CCA metastasis features both synchronous and dyssynchronous presentations.…”

A colonic metastasis from extrahepatic cholangiocarcinoma after removal of primary tumor: a case report and literature review

“…Initially, Wakahara reported a male patient with intrahepatic cholangiocarcinoma (ICC) with sigmoidectomy metastasis in 2005 (2). The other six cases were reported in the year of 2010, 2011, 2012, and 2016, respectively (Table 1) (3)(4)(5)(6)(7)(8). The mean age of these patients is 63.6 (range, 57-76).…”

Colon Mass as a Secondary Metastasis from Cholangiocarcinoma: A Diagnostic and Therapeutic Dilemma

“…After the metastasis to the brain, he received 300 cGy radiation to the whole brain but the family refused the treatment after one dose of the treatment. The patient died 17 days after the last treatment [6]. Another patient presented with an intestinal obstruction caused by metastasis that manifested six years after surgery for intrahepatic cholangiocarcinoma (ICC), which was confirmed by histopathology.…”

“…Colon metastasis of cholangiocarcinoma is very rare, and only three cases have been reported thus far with metastases [6-8] and one case with infiltration [9]. We report the fourth case of metastasis from cholangiocarcinoma to the colon to bring awareness about the proper diagnosis and management of uncommon sites of metastases as it poses a diagnostic as well as a therapeutic challenge to both patients and the treating physicians.…”