Sotelo-Martínez L, Sánchez-Luna C

Language: Spanish
References: 8
Page: 260-266
PDF size: 437.93 Kb.

ABSTRACT

An extrahepatic cholangiocarcinoma is a malignant tumor of the ductal epithelium of the bile duct, type adenocarcinoma. It is found most commonly in the hepatic hilum (Klatskin tumor) and less often in the distal portion of the bile duct. Its presentation is rare, with very poor prognosis, and treatment is surgical. Suspicion of cholangiocarcinoma is based on signs of biliar obstruction: jaundice, acholia, choluria, and pruritus, as well as high alkaline phosphatase and bilirubin. Elevation of the tumor marker CA 19-9 is not specific, although it is observed in up to 85% of patients. Abdominal ultrasound is the imaging method of first contact in an obstructive condition of the bile duct to prove dilation of the intrahepatic bile duct, viewing the intraductal tumoral lesion (sensitivity 87-96%). By endoscopic ultrasound, samples can be obtained by fine needle aspiration with 25-91% sensitivity and 89-100% specificity. Dynamic computed tomography with biliopancreatic protocol confirms bile duct dilation and the tumor obstruction site and shows the tumoral type as a persistent and progressive early heterogeneous highlight, the infiltrating type as thickening and reinforcement of the wall, and the polypoid type as an intraluminal mass with heterogeneous reinforcement. The findings from magnetic resonance are similar to those of tomography. In the weighted sequence, in T1 the tumor is hypo- to isointense, in T2 it is slightly hyperintense, and in the dynamic study with contrast medium it shows mild or heterogeneous early reinforcement, with progressive persistent highlight in late phase. Resonance is superior to tomography for evaluating intraductal lesions, with sensitivity and specificity above 90%. The combination of simple tomography with fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET/CT) detects cholangiocarcinoma due to increased glycolytic metabolism with 90% sensitivity for the nodular type and 18% for the infiltrative type. The full body study is useful in metastatic disease, local tumor relapse, and in regional lymph nodes.

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