Cholangiocarcinoma in Pregnancy: Literature Review and Case Report

Abstract

Introduction: Hepatobiliary malignancies during pregnancy are extremely rare, with probably around 11 published cases of cholangiocarcinoma (CCA) in pregnant woman. Case report: A 35 years-old pregnant woman, 34 weeks pregnant, with 2 weeks of cholestasis. Exams reveals total bilirubin of 7.08 mg/dL, AST 97 U/L, ALT 131 U/L, CA 19-9 7724 U/mL and CEA 11 ng/ml. MRI showed a 4.0x3.5 cm mass in hepatic confluence, suspicion of CCA, with right portal and hepatic artery invasion. One week later, bilirubin raised to 13 mg/dL, and cesarean was permorfed. Percutaneous biopsy was performed and moderately differentiated CCA was confirmed. Multidisciplinary team decided for bilateral external transhepatic biliary catheter placement and right portal vein embolization before the surgery. Exploratory laparoscopy demonstrated a small and unique peritoneal implant in the hepatorenal area. Was decided to continuous with the surgery, and a right hepatic trisegmentectomy with Roux-en-Y biliary anastomosis was performed. After six weeks, she has started chemotherapy. The total survival was 2,4 years. Discussion/ conclusion: Cholangiocarcinoma is a rare malignancy encountered even more rarely during pregnancy. Termination of pregnancy and rapid initiation of chemotherapy may be an option in patients in the third semester of pregnancy. The role of palliative surgery in this setting is not determined in literature, but we know that many CCA patients die of cholangitis. Cancer in pregnancy marks an emotional and devastating diagnosis that requires a multidisciplinary approach to management. Each case needs to be considered individually and there are no consensus guidelines and few cases reports.