Xiao Chao, Cao Cheng-Jian, Xiao Xue, Cheng Qi-Jun
Department of Obstetrics and Gynecology, The First People's Hospital of Zigong, Zigong, China.
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.
Front Med (Lausanne). 2024 Oct 23;11:1449865. doi: 10.3389/fmed.2024.1449865. eCollection 2024.
Cholangiocarcinoma (CCA) is a tumor that arises from the epithelium of the intrahepatic bile ducts. It is rarely diagnosed in individuals under 40 years of age and has a very aggressive nature: 95% of patients die within 5 years. We present the first detailed report of a case of perihilar CCA (pCCA) presenting during pregnancy masquerading as intrahepatic cholestasis of pregnancy (ICP). First, the patient exhibited typical pruritus, particularly in her limbs; second, a raised biomarker of total bile acid (TBA) was noted; third, the onset occurred in the second trimester, aligning with the epidemiological profile; and finally, importantly, there was no mass detected in her liver. First-line drugs were given to treat ICP, but they failed, and ultimately, the condition was identified as pCCA. Following an inadequate excision, traditional Chinese medicine was administered. After 26 months, she succumbed to cachexia. As gestational symptoms are sometimes associated with pregnancy-related disorders, pCCA in pregnant women is frequently misdiagnosed. Symptoms such as jaundice, pruritus, and dilated bile ducts in pregnant women may indicate pCCA. In addition, the appropriate treatment for pCCA in pregnant women may be surgery or chemotherapy; if surgery is not an option, chemotherapy may also help extend the gestational week. Our work is important and can educate on the diagnosis and treatment of pregnancy-related diseases, such as ICP and pCCA.
胆管癌（CCA）是一种起源于肝内胆管上皮的肿瘤。40岁以下的个体很少被诊断出患有该病，且其具有极强的侵袭性：95%的患者会在5年内死亡。我们首次详细报告了一例在孕期表现为妊娠肝内胆汁淤积症（ICP）的肝门周围胆管癌（pCCA）病例。首先，患者出现典型的瘙痒症状，尤其是在四肢；其次，总胆汁酸（TBA）生物标志物升高；第三，发病发生在孕中期，与流行病学特征相符；最后，重要的是，其肝脏未检测到肿块。给予一线药物治疗ICP，但治疗失败，最终该病症被确诊为pCCA。在进行了不充分的切除术后，给予了中药治疗。26个月后，她死于恶病质。由于妊娠症状有时与妊娠相关疾病有关，孕妇的pCCA常被误诊。孕妇出现黄疸、瘙痒和胆管扩张等症状可能提示pCCA。此外，孕妇pCCA的适当治疗方法可能是手术或化疗；如果无法进行手术，化疗也可能有助于延长孕周。我们的工作很重要，可为妊娠相关疾病（如ICP和pCCA）的诊断和治疗提供指导。
