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World J Gastrointest Endosc. Dec 16, 2010; 2(12): 404-407
Published online Dec 16, 2010. doi: 10.4253/wjge.v2.i12.404
Published online Dec 16, 2010. doi: 10.4253/wjge.v2.i12.404
Use of endoscopic ultrasound for diagnosis of cholangiocarcinoma in auto-immune hepatitis
Nathaniel S Rial, Department of Internal Medicine, College of Medicine, Arizona Cancer Center and Mel & Enid College of Public Health, The University of Arizona, Tucson, AZ 85724 United States
Jeff T Henderson, Arizona Digestive Health Pathology Laboratory, AZ 85006 United States
Achyut K Bhattacharyya, Director Surgical Pathology, Professor and Head Department of Pathology, College of Medicine, The University of Arizona, Tucson, AZ 85724 United States
Abdul Nadir, John T Cunningham, Department of Gastroenterology, College of Medicine, The University of Arizona, Tucson, AZ 85724 United States
Author contributions: Rial NS wrote the manuscript; Nadir A and Cunningham JT were responsible for acquisition of tissue samples by ERCP; and Henderson JT and Bhattacharyya AK provided supportive work, materials and technology.
Correspondence to: Nathaniel S Rial, MD, PhD, CPH, Department of Internal Medicine, College of Medicine, The University of Arizona, Tucson, AZ 85724, United States. nsrial@email.arizona.edu
Telephone: +1-520-6262761 Fax: +1-520-6266020
Received: August 9, 2010
Revised: October 26, 2010
Accepted: November 2, 2010
Published online: December 16, 2010
Revised: October 26, 2010
Accepted: November 2, 2010
Published online: December 16, 2010
Abstract
In this report, a patient was exposed to an herbal remedy for hypercholesterolemia. She became acutely jaundiced while taking the remedy and presented for medical care. Endoscopic ultrasound was utilized, and found a distal common bile duct mass. Endoscopic retrograde cholangiopancreatography guided bile duct biopsies revealed that the mass was cholangiocarcinoma (CCA). This case highlights a unique association between autoimmune hepatitis and CCA. It also highlights that EUS can be safely used in patients with cirrhosis to spare invasive evaluation such as exploratory laporotomy for diagnosis and staging of cholangiocarcinoma.