Image 3 Cytology brushings from CBD and CHD are reported as adenocarcinoma. Image 4 Repeat ERCP two months later showed no change. CA 19-9 is negative, standard LFTs are normal. We are presented with a young asymptomatic patient with PSC and no evidence of liver dysfunction. If we take an expectant approach and the patient has CCA we may miss the opportunity to act when resection for cure may still be possible.
Surgery is the only curative modality.
Palliative therapy consists of stenting of a dominant stricture, external beam radiation, brachytherapy and chemotherapy. Followup 15 months later. There was much discussion about this case. Cholecystectomy was performed. The duct was not easily available for inspection or additional diagnostic measures.