Shaik Mohammed R, Shaik Nishat A, Bilgrami Zaid, Wheeler Erika, Chow Robert Td
Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, United States.
Department of Medicine, Guntur Medical College, Guntur, Andhra Pradesh, India.
J Community Hosp Intern Med Perspect. 2023 Jun 29;13(4):35-41. doi: 10.55729/2000-9666.1198. eCollection 2023.
The incidence of cholangiocarcinoma, an aggressive malignancy with poor prognosis, is increasing. Hepatitis B and C have been well established as predisposing factors for this malignancy. The availability and efficacy of treatment for hepatitis C infection has led to a substantial reduction in viral hepatitis-related cholangiocarcinoma mortality. Despite treatment, the potential for developing cholangiocarcinoma continues to exist for patients with underlying cirrhosis. We present a patient who was effectively treated for hepatitis C with direct-acting antiviral therapy eight years prior. He presented with malaise, fatigue, and an unintentional weight loss of 40 pounds. Imaging revealed a metastatic malignancy, and a liver biopsy confirmed the diagnosis of cholangiocarcinoma and the absence of underlying cirrhosis in the background liver. This case highlights the persistent risk of developing cholangiocarcinoma despite achieving sustained virological response to treatment for hepatitis C. We review the associated literature and briefly discuss the predisposing conditions that might result in such an outcome. We also encourage the need for long-term surveillance for such patients and the importance of conducting more multi-center studies to identify at-risk patients and develop cost-effective screening protocols.
胆管癌是一种侵袭性恶性肿瘤，预后较差，其发病率正在上升。乙型和丙型肝炎已被确认为这种恶性肿瘤的诱发因素。丙型肝炎感染治疗方法的可得性和有效性已使病毒性肝炎相关胆管癌的死亡率大幅降低。尽管进行了治疗，但潜在肝硬化患者发生胆管癌的可能性仍然存在。我们报告一名患者，其八年前接受了直接抗病毒疗法有效治疗丙型肝炎。他出现不适、疲劳，体重意外减轻40磅。影像学检查显示为转移性恶性肿瘤，肝脏活检确诊为胆管癌，且背景肝脏中无潜在肝硬化。该病例突出了尽管丙型肝炎治疗实现了持续病毒学应答，但仍存在发生胆管癌的持续风险。我们回顾了相关文献，并简要讨论了可能导致这种结果的诱发条件。我们还鼓励对此类患者进行长期监测的必要性，以及开展更多多中心研究以识别高危患者并制定具有成本效益的筛查方案的重要性。
