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Cholangiocarcinoma in Wilson’s Disease – a Case Report

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Dániel Németh1, Anikó Folhoffer1, Gábor Smuk2, Béla Kajtár2, Tamás Tornóczky2, Ferenc Szalay1

1) 1st Department of Internal Medicine of Semmelweis University, Budapest;
2) Department of Pathology of the University of Pécs, Pécs, Hungary

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.263.nem

ABSTRACT
It has been suggested that hepatobiliary carcinomas are less frequent in Wilson’s disease (WD) than in liver diseases of other etiology. However, the protective role of copper against malignancies is debated. Only a few cases of cholangiocarcinoma (CCC) in WD have been published. Here we report on a case of a 47-year-old male H1069Q homozygous, Kayser-Fleischer ring positive WD patient with a low ceruloplasmin level who was followed up and treated with chelating agents throughout nine years. The patient presented with neurological symptoms and liver cirrhosis at diagnosis. Clinical symptoms regressed after the treatment initiation. Rapidly developed tumour metastases were found in the bones, lung and liver (without jaundice). Autopsy revealed cholangiocarcinoma as the primary tumour confirmed by strong CK7 positivity and glypican-3 negativity. The curiosity of the presented case is the very rapid development of CCC despite continuous chelating agent therapy.
Key words: copper chelating agents – Wilson’s disease – cholangiocarcinoma – hepatolenticular degeneration – liver cirrhosis.
Abbreviations: CCC: cholangiocarcinoma; HCC: hepatocellular carcinoma; WD: Wilson disease.