1062 Unusual Lesion of the Bile Duct Diagnosed With Digital Cholangioscopy and Biopsy

      Metastatic urothelial cancer usually spreads to regional lymph nodes and hematogenously to liver, lung, bone, adrenal glands and intestine. Unusual sites of metastatic disease have been reported to heart, brain, kidney, spleen, pancreas, meninges, uterus ovary prostate and testes. Intraductal endoscopy has the promise of increasing the diagnostic yield in both benign and malignant disease. Recent improvements in technology and wider availability permits for accurate diagnosis of unusual cases. We present a case where intraductal endoscopy allowed for targeted biopsies to diagnose metastatic urothelial cancer to the left intrahepatic duct. A 73 year-old male with a history of a left nephrectomy and ureter resection in 2010 was found to have dilated left intrahepatic ducts and elevated liver function tests on a routine MRI for pre-operative planning. He was asymptomatic without any nausea, vomiting, or abdominal pain. He presented for ERCP. There was a filling defect noted in the left hepatic duct on cholangiogram. Intraductal endoscopy was then utilized to visualize a frondular lesion within the left intrahepatic duct. Targeted biopsies were obtained. Pathology demonstrated metastatic high grade urothelial carcinoma consistent with metastatic carcinoma.
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