DDSEP® 8 Quick Quiz

November 2019

Publish date: October 30, 2019

Q1. You are evaluating a 77-year-old man for obstructive jaundice and weight loss. The patient reports an approximate 25-pound weight loss over the last month. He denies abdominal pain. Labs reveal a total bilirubin of 17.5 mg/dL, alkaline phosphatase of 441 IU/L, aspartate aminotransferase of 60 IU/L, alanine aminotransferase of 70 IU/L, lipase of 41 U (ULN 50 U) and WBC of 8 × 109/L. A right upper quadrant ultrasound is obtained and shows intra- and extrahepatic biliary dilation up to 2 cm. A subsequent pancreas protocol CT is notable for narrowing of the mid bile duct with a normal downstream common bile duct. A mass is not visualized within the pancreas. CA 19-9 is elevated to 1900 U/mL and CEA is 8 ng/ mL. You are concerned for a possible extrahepatic cholangiocarcinoma.

Which of these is not a risk factor for cholangiocarcinoma?

PSC

Type IV choledochal cyst

Opisthorchis viverrini infection

Obesity

Cirrhosis

Fasciola hepatica infection

Q1. Correct answer: F

Rationale
There are a number of known risk factors for cholangiocarcinoma including PSC, choledochal cysts, obesity, chronic liver disease, toxins such as Thorotrast as well as liver flukes including those in the Opisthorchis and Clonorchis genus. While Fasciola does infect the liver, an association has not been reported with cholangiocarcinoma.

References
1. Fevery J, et al. Malignancies and mortality in 200 patients with primary sclerosering cholan¬gitis: a long-term single-centre study. Liver Int. 2012;32(2):214-22.
2. Razumilava N, Gores GJ, Lindor KD. Cancer surveillance in patients with primary sclerosing cholangitis. Hepatology. 2011;54(5): 1842-52.
3. Williamson KD, Chapman RW. Primary sclerosing cholangitis: a clinical update. Br Med Bull. 2015;114(1):53-64.

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