PMC6053549_01
Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) imaging of metastatic cholangiocarcinoma (CCA) demonstrating left psoas muscle fullness and urinary bladder wall thickening. (A) Suspected biliary stricture (arrow) on transverse section of MRCP. (B) Left psoas muscle fullness (arrow), in addition to urinary bladder wall thickening on transverse section of abdominal CT. (C) Left psoas muscle fullness (arrow) on coronal section of MRCP. (D) Urinary bladder wall thickening (arrow) on coronal section of abdominal CT.
CG-CGCR180034F001.jpg
PMC6053549_01_CG-CGCR180034F001.jpg
F1
Magnetic resonance cholangiopancreatography (MRCP) showed diffuse gastric wall thickening, left psoas muscle fullness with left hydronephrosis, bladder mucosal enhancement, and intrahepatic dilatation despite biliary stenting (Figure 1).
Fluoroscopy image of biliary stricture on ERCP revealing Bismuth-Corlette type II classification, with the tumor reaching the confluence of the left and right hepatic ducts.
CG-CGCR180034F002.jpg
PMC6053549_01_CG-CGCR180034F002.jpg
F2
A second ERCP with stent exchange was performed; however, biliary biopsies were not obtained due to previous negative cytology and the unavailability of an endoscopic ultrasound-guided cholangioscope (Figure 2).
(A) CK7 and (B) CK19 staining of percutaneous biopsy of left psoas muscle with tumor cells, confirming metastatic CCA and ruling out alternative malignancies and etiologies.
CG-CGCR180034F003.jpg
PMC6053549_01_CG-CGCR180034F003.jpg
F3
CCA-specific cytokeratin (CK) 7 and CK19 (Figure 3). Cystoscopy demonstrated trigonal fluffy tissue obscuring the left ureteral orifice, with pathology consistent with CCA.
Upper endoscopy showing gastric metastases of CCA as linitis plastica.
CG-CGCR180034F004.jpg
PMC6053549_01_CG-CGCR180034F004.jpg
F4
ERCP. Esophagogastro-duodenoscopy showed a rigid stomach creating a challenging duodenal intubation (Figure 4).