Hepatitis C: Culprit for Cholangiocarcinoma

Abstract

Cholangiocarcinoma, a relatively rare adenocarcinoma originating from the epithelial cells of the bile ducts, typically has a late presentation and generally poor prognosis. Known risk factors include primary sclerosing cholangitis, biliary cysts, parasites and toxins. Chronic viral hepatitis has been proposed as a possible risk factor, although its role in the development of cholangiocarcinoma has been indeterminate. We present an unusual case of intrahepatic cholangiocarcinoma in a female with chronic hepatitis C (HCV) and cirrhosis.A 63 year old female with a history of left breast DCIS (s/p surgery and radiation) and chronic HCV with compensated cirrhosis was referred for HCV management. Previous treatment included Harvoni (Ledipasvir sofosbuvir) and Zepatier (Elbasvir and grazoprevir) which were both self-discontinued due to reported side effects prior to eradication. Surveillance CT scan, performed for hepatocellular carcinoma (HCC) screening, identified a 2.2 hepatic mass without washout. Given that she did not have classic radiologic features of HCC, a liver biopsy was performed. The biopsy revealed moderately differentiated adenocarcinoma, most consistent with intrahepatic cholangiocarcinoma (immunostaining positive for CK7 and CK19) and negative for hepatocellular carcinoma and markers for breast cancer. Labs included liver enzymes (AST 21, ALT 31, Alk Ph 73, bilirubin 1.2), normal PT/INR, AFP 98.9 and CA19-9 of 225. An EGD and colonoscopy were normal. A PET scan did not have any increased in metabolic uptake. She was referred to surgery and underwent an uncomplicated hepatic resection with the specimen consistent with cholangiocarcinoma. She was referred to oncology for continued management. Our case supports the potential association between HCV and the development of intrahepatic cholangiocarcinoma. Further research to understand the potential role of HCV and development of cholangiocarcinoma is needed. This case also illustrates the importance of HCV eradication to prevent cancer and improve medical outcomes.