Intrabiliary growth of colic cancer metastasis: A case report and literature review

Author(s): Rami Guizani, Aziz Atallah, Mohamed Hajri, GhofraneTalbi, Wael Ferjaoui, Hafedh Mestiri, Rached Bayar, Sana Ben Slama, Ahlem Lahmar, Nedia Ben Othmen, and Dhouha Bacha

Introduction: Biliary metastasis of colorectal cancer is a rare association with metastatic liver carcinoma. Differential diagnosis with cholangiocarcinoma can be difficult but must be established in order to offer the best therapeutic strategy. Case presentation: We report the case of a 39 years old woman who has undergone subtotal colectomy with ileocolic anastomosis for occluded sigmoid cancer. Histological examination revealed well-differentiated adenocarcinoma pT3N0M0 with perineural and vascular invasion. Adjuvant chemotherapy was undergone. Three years later, a resection of the segment I for liver metastasis was performed. The microscopic examination concluded to adenocarcinoma from a primary colic cancer. Two years later, wedge resection of two liver nodules of segment IV and VIII and a cholecystectomy was performed. Each time surgical margins were negative. In December 2019, follow-up biology revealed elevated carcinoembryonic antigen. A liver metastasis in segment VIII and a suspicious hepatic hilum ganglion were revealed in imaging. Chemotherapy was conducted. Control imaging showed total regression of segment VIII metastasis and a slight increase in the size of the hilum mass. The patient was operated on preoperative examination showed a mass hanging from the right edge of the hepatic pedicle. Its resection resulted in the loss of substance from the left hepatic duct. Macroscopic examination revealed intrabiliary growth. Histological examination revealed carcinomatous metastasis compatible with the first colic cancer. Resection margins were negative. Conclusion: Intrabiliary growth can have a deceptive presentation. The mechanism and prognosis are not clear. Surgical resection appears to be an acceptable treatment.