Metastatic Cancer of the Extrahepatic Bile Ducts Producing Jaundice

Herbut, Peter A.; Watson, John

doi:10.1093/ajcp/16.6.365

Cited by 20 publications

(12 citation statements)

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“…Biliary metastasis from colon cancer is an extremely rare manifestation of colon cancer since its first report by Herbut and Watson3 in 1946. Some suggest that isolated intrahepatic biliary metastasis can be regarded as a variant of hepatic metastasis which are less aggressive and have a better prognosis than the typical parenchymal liver metastasis of colon cancer 456789.…”

Section: Discussionmentioning

confidence: 99%

Biliary metastasis in colorectal cancer confers a poor prognosis: case study of 5 consecutive patients

Koh

Wang

Tan

2017

Ann Hepatobiliary Pancreat Surg

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The biliary duct is an extremely rare site for colon cancer metastasis. It often leads to a diagnostic dilemma, since primary cholangiocarcinoma (potentially treatable with surgery) has a similar presentation. This paper highlights our experience with 5 consecutive patients who had colon malignancy with biliary metastasis, and prognosis of their disease. Five patients, with a history of primary colon cancer since 2010, were identified to have biliary metastasis. Of these, 4 (80.0%) patients were male. The median time to diagnosis of biliary metastasis from diagnosis of colon cancer was 59.2 months (0-70.1 months), and all exhibited symptoms of biliary obstruction or its associated complications. Evaluation of the tumour samples revealed all specimens to be negative for CK7 but positive for CK20, suggestive of a colorectal primary. The median survival of the 5 patients was 23.5 months (1.8-44.5 months) from the diagnosis of biliary metastasis. However, none of their death was related to the direct complication of biliary obstruction. Biliary metastasis is a rare entity for metastatic colon malignancy. Diagnosis may be difficult radiologically, and immunohistochemical staining may help in identification. The overall survival for these patients is dismal.

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Section: Discussionmentioning

confidence: 99%

Biliary metastasis in colorectal cancer confers a poor prognosis: case study of 5 consecutive patients

Koh

Wang

Tan

2017

Ann Hepatobiliary Pancreat Surg

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“…Intrabiliary growth of metastatic carcinoma was first reported in 1946 with symptomatic jaundice, biliary dilatation, and cirrhosis on autopsy [ 6 ]. Study from MD Anderson Cancer Center revealed that the primary lesions of intrabiliary growth of hepatic metastasis are composed predominantly of colorectal carcinoma (93%), among which the rectosigmoid colon is the most common site of the primary tumor [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Intrabiliary Hepatic Metastasis of Colorectal Carcinoma Mimicking Primary Cholangiocarcinoma: A Case Report and Review of the Literature

Dong

Patel

2016

Case Reports in Pathology

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Intrabiliary metastasis from colorectal carcinoma (CRC) growing within or invading bile ducts is not a very common pattern. However, accurate diagnosis of metastatic lesions is very important for selection of adjuvant therapy and prognosis. We report a case of 71-year-old male who developed painless jaundice due to hepatobiliary obstruction. MRI demonstrated 1.4 cm intraductal mass at hepatic hilum with severe intrahepatic ductal dilation, consistent with cholangiocarcinoma. ERCP (endoscopic retrograde cholangiopancreatography) showed intraductal segmental biliary stricture. Biopsy from the lesion showed adenocarcinoma favoring primary cholangiocarcinoma due to the papillary morphology and location of the mass. His past history was significant for rectosigmoid carcinoma (pT1N0) ten years ago and liver resection for metastatic CRC four years ago. He subsequently underwent central hepatectomy with resection of common bile duct. Grossly, there was a 1.2 cm intraductal mass at the bifurcation of bile ducts with multiple nodules in liver parenchyma. Microscopic examination revealed intraductal carcinoma with papillary architecture colonizing bile duct epithelium with resultant dilation and tortuosity. Occasional liver parenchymal nodules show classical metastatic pattern resembling CRC. Because of two distinct morphologic patterns and patient's past history, immunostains were performed. CK7 stained uninvolved bile duct epithelium with no staining in intrabiliary metastatic growth. CK20 and CDX2 were positive, thus confirming intrabiliary growth as metastatic growth from CRC. In summary, findings from our case indicate that intrabiliary growth of metastatic CRC can easily be overlooked with major duct involvement. Pathologic evaluation with use of immunohistochemical stains is very important to achieve correct diagnosis.

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“…In 1946, Herbut and Watson18 reported a 60-year-old man who presented with jaundice and abdominal distension due to widely metastatic colonic carcinoma; at autopsy, there were multiple polypoid masses of metastatic tumor growth in the common hepatic duct, resulting in dilatation of the proximal biliary tree and biliary cirrhosis. Since that time, there have been several case reports describing intrabiliary growth of metastatic CRCs 1,5,6,11–13.…”

Section: Discussionmentioning

confidence: 99%

Intrabiliary Growth of Liver Metastases

Estrella¹,

Othman²,

Taggart³

et al. 2013

American Journal of Surgical Pathology

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Intrabiliary growth by metastatic colorectal carcinoma (CRC) is an unusual finding that can clinically mimic cholangiocarcinoma. We evaluated prevalence of intrabiliary growth by retrospective review of 1596 diagnostic reports and by prospective evaluation of 223 hepatectomies. Positive cases were scored for extent of intrabiliary growth (major vs. minor duct involvement), architectural pattern (colonization of biliary epithelium and/or intrabiliary tumor plugs), and secondary sclerosing cholangitis in non-neoplastic parenchyma. By retrospective review, we identified intrabiliary growth in 41 (3.6%) of 1144 metastatic CRCs but only 3 (0.7%) of 452 noncolorectal tumors (P<0.001). Prospectively, we found intrabiliary growth in 18 (10.6%) of 170 metastatic CRCs and 1 (1.9%) of 53 other tumors (P=0.05). Among our final population of 43 CRCs with intrabiliary growth, 24 (56%) had major and 19 (44%) had minor duct involvement, 35 (81%) showed colonization of biliary epithelium, and 35 (81%) showed intrabiliary tumor plugs. Compared with minor duct involvement and 51 controls without intrabiliary growth, major duct involvement was more likely to produce obstructive liver chemistries (P=0.004), radiographic evidence of biliary disease (P<0.0001), and sclerosing cholangitis in non-neoplastic liver (P<0.0001). However, there was no impact on overall survival. Clinically, 5 (21%) cases of major duct involvement resulted in diagnostic uncertainty between metastatic CRC and cholangiocarcinoma. These findings underscore the frequency of intrabiliary growth by metastatic CRCs and its rarity with other metastases. Major duct involvement should be recognized because of its distinctive clinical features, which can overlap with cholangiocarcinoma.

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Metastatic Cancer of the Extrahepatic Bile Ducts Producing Jaundice

Cited by 20 publications

References 0 publications

Biliary metastasis in colorectal cancer confers a poor prognosis: case study of 5 consecutive patients

Biliary metastasis in colorectal cancer confers a poor prognosis: case study of 5 consecutive patients

Intrabiliary Hepatic Metastasis of Colorectal Carcinoma Mimicking Primary Cholangiocarcinoma: A Case Report and Review of the Literature

Intrabiliary Growth of Liver Metastases

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