An Unusual Presentation of Advanced Intrahepatic Cholangiocarcinoma: When Biopsy Results Fail

BACKGROUND Intrahepatic cholangiocarcinoma is a rare condition which typically occurs in males between 50 and 70 years of age, and presents with symptoms related to biliary obstruction including jaundice, pruritus, and dark urine. Other common symptoms at presentation include abdominal pain, weight loss, and fever. CASE REPORT We present a case of a 67-year-old female initially presenting with chest pain at rest, found to have a lung nodule on diagnostic imaging at the time of admission. On further imaging, a 9 cm liver lesion was incidentally discovered, initially suspicious for hepatocellular carcinoma on imaging, with initial biopsy staining CK7 positive, and CK20 negative. The patient also had an elevated alpha-fetoprotein level. Biopsy results were later confirmed as moderately differentiated adenocarcinoma consistent with intrahepatic cholangiocarcinoma. CONCLUSIONS This report illustrates an unusual presentation of intrahepatic cholangiocarcinoma. Although rare, cholangiocarcinoma is diagnosed most frequently as an incidental finding on imaging studies. With quick work-up and successful biopsy results, patients can undergo surgical or chemo-radiation therapy earlier, potentially leading to a longer survival time.