P1.096. Oesophageal Adenocarcinoma Metastasising to the Common Bile Duct: A Case Report

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ID: 326220
2026
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Ranked #270 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Esophageal Cancer: Esophageal Carcinogenesis Case Submission A 58 year old man with oesophageal adenocarcinoma, presented with a 4 day history of right upper quadrant pain, jaundice, dark urine and pale stools. Laboratory tests showed a serum bilirubin of 179umol/L, alkaline phosphatase 252U/L, gamma glutamyl transferase 202U/L, alanine aminotransferase 142U/L and aspartate aminotransferase 67U/L. A contrast-enhanced CT of the abdomen and pelvis demonstrated marked intrahepatic duct dilatation with rapid tapering and nodular circumferential mural thickening of the common hepatic duct and confluence (see figure). The patient underwent Endoscopic Retrograde Cholangiopancreatography (ERCP) which confirmed a tight segmental stricture 3cm in length at the lower two thirds of the common bile duct and an approximately 1.5cm dilation of the common hepatic bile duct (see figure). A metal stent was placed in the common bile duct. Histopathology of the brushings collected during ERCP demonstrated adenocarcinoma cells with increased nuclear to cytoplasmic ratio and hyperchromasia (see figure). Immunohistochemistry demonstrated CK7 positivity supportive of oesophageal adenocarcinoma (see figure). Current literature suggests that oesophageal carcinomas rarely metastasises to the common bile duct. To the best of our knowledge, oesophageal adenocarcinoma metastasising to the common bile duct has not been described previously. The patient presented with classical features of obstructive jaundice and a cholestatic liver enzyme derangement. Contrast-enhanced CT imaging demonstrated intrahepatic biliary dilatation with circumferential mural thickening and abrupt tapering of the common hepatic duct, features typically associated with cholangiocarcinoma. ERCP confirmed a tight segmental stricture involving the distal common bile duct with upstream biliary dilatation. Biliary decompression was achieved with placement of a self-expanding metal stent, consistent with current endoscopic management of malignant biliary obstruction. This highlights the dual diagnostic and therapeutic role of ERCP in such presentations. A key learning point from this case is the importance of tissue acquisition in patients with indeterminate biliary strictures, particularly in those with a known extra-biliary primary malignancy. Although radiologic and endoscopic findings strongly suggested primary cholangiocarcinoma, brush cytology obtained during ERCP demonstrated malignant glandular cells. Immunohistochemical analysis showing CK7 positivity supported an upper gastrointestinal origin and confirmed metastatic oesophageal adenocarcinoma. This emphasises the critical role of cytology and immunophenotyping in distinguishing primary biliary tumours from metastatic disease. Another important learning point is that metastatic disease to the bile duct, while rare, should remain part of the differential diagnosis in patients with known oesophageal malignancy. True intraductal metastasis is uncommon and is thought to occur via haematogenous or lymphatic dissemination rather than direct invasion. Failure to consider this possibility may result in misdiagnosis and inappropriate referral for surgical resection.
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Authors Saad Shams Bin Shaheen, Cameron Gofton, Cameron Bell
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.244
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.244/70761114/doag077.244.pdf
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