Painless obstructive jaundice leading to diagnosis of extrahepatic cholangiocarcinoma: a case study and review

Abstract

A 26-year-old woman presented with jaundice, which results from raised serum bilirubin (hyperbilirubinemia) as a consequence of a number of underlying pathologies. Timely diagnosis is challenging but essential for prognosis and any possible treatment. To compare the many differential diagnoses, the hepatobiliary nurse specialist undertook a systems review and arranged an abdominal ultrasound and blood tests. The patient's medical history excluded autoimmune and metabolic conditions, including haemolytic anaemia, primary biliary cholangitis, primary sclerosing cholangitis, Wilson's disease and Gilbert syndrome. In terms of infectious causes of jaundice, schistosomiasis, liver flukes and Weil syndrome, as well as cholelithiasis and cholecystitis were also excluded. However, some symptoms and biomarkers linked with hepatitis A, B and C warranted consideration. Neoplastic disorders were thought unlikely due to the patient's young age but signs of biliary obstruction meant hepatobiliary cancer could not be excluded. Computerised tomography and endoscopic retrograde cholangio-pancreatography showed an obstructive stricture resulting from a 4.4 cm-wide periportal mass, although biliary brush cytology was inconclusive as to its malignancy. Endoscopic ultrasound and fine needle aspiration confirmed extrahepatic cholangiocarcinoma. Magnetic resonance imaging staging confirmed metastases that precluded surgery, and the patient died 4 months later.