Cholangiocarcinoma Differential Diagnosis

Cholangiocarcinoma must be differentiated from all other biliary obstructive

lesion, hepatocellular carcinoma, ampullary carcinoma, and also pancreatic
carcinoma.Cholangiocarcinoma and primary sclerosing cholangitis is a problematic to
distinguish.(1) In patients with primary sclerosing cholangitis the most reliable cutoff
for intrahepatic cholangiocarcinoma is 129 U/mL with ERCP and other imaging
finding as a support diagnosis assessment.(3) Most patient who present with a
stricture of biliary hilus and jaundice will have carcinoma, although 10 percent of the
will show the different disease. The most differential diagnosis if the disease occurs
in bile duct and ampulla is gallbladder cancer. Patient with gallbladder cancer will
show a thickened, irregular gallbladder on crossectional imaging often with invasion
into segment IV and V of the liver. Mirizzi syndrome which results from the
impaction of a large gallbladder stone in its neck also mimics cholangiocarcinoma.
This syndrome may cause secondary periductal and percystic inflammation and
proximal bile obstruction. A dilated common bile duct, with a distal stricture and
normal appearing pancreatic duct is suggestive ampullary or bile duct cancer.(1)
Intrahepatic cholangiocarcinoma could be differentiated with hepatocellular
carcinoma.(2) If the intrahepatic lesion is appear in a setting of cirrhosis liver, it
should be differentiating with hepatocellular carcinoma. hepatocellular carcinoma
lesions are associated with hyperenhancement in the arterial phase and contrast
washout in the venous phase of a contrast enhanced imaging study.(3) The most liver
test that helpful to detect hepatocellular carcinoma is -fetoprotein, which will be
elevated but are not generally elevated in cholangiocarcinoma. Patient with rapid and
dramatic change in previously stable cirrhosis must always be suspected of HCC.(1)
Patient with Ampullary carcinoma may presents many same features with
cholangiocarcinoma,

but

diarrhea

is

not

commonly

associated

with

cholangiocarcinoma.(2) In Ampullary carcinoma, USG will demonstrate the level of

obstruction and resulting biliary dilatation without detectable mass in pancreas.
MRCP anD ERCP also helpful to distinguish with cholangiocarcinoma. Distal
cholangiocarcinoma is less aggressive than pancreas carcinoma.(3)

Pancreatic tumor also must be distinguish with cholangiocarcinoma. CT or

MRI are the modality to investigate whether the tumor arising from the body of
pancreas. Patien with pancreas tumor will present a significant weight loss, epigastric
or back pain which is not commonly seen in cholangiocarcinoma.(1,2,3)
Cholangitis and Choleodocholithiasis are also the differential diagnosis for
cholangiocarcinoma. In cholangitis, is typically as triad of fever, right upper quadrant
pain, and jaundice. WBC count must be elevated , positive blood culture and imaging
should be done. ERCP is effective to diagnose the choleodocolithiasis.(2)

Daftar Pustaka
1. Current Diagnosis & treatmen in gastroenterology 2 nd editon,
2. bestpractice.bmj.com/bestpratice/monograph/721/diagnosis/differential.html
Access 10 Oktober 2016
3. Razumilava N, Gores G J : Cholangiocarcinoma.Lancet. February
2016;383:2168-79