Intrabiliary metastasis of colorectal adenocarcinoma: the SPY perspective

We report a case of a 54-year-old female that underwent sigmoidectomy for stage IIA adenocarcinoma. After 5 years of follow-up, despite normal colonoscopy and CEA and CA-19.9 levels, abdominal CT revealed a 3 cm perianastomotic peritoneal lesion and suspected liver metastasis. Although liver biopsy was negative for malignancy, the perianastomotic lesion was confirmed to be metastasis of colonic adenocarcinoma. After chemotherapy, a mild elevation of alkaline phosphatase and γ-GT was evident. MRCP revealed dilation of intrahepatic bile ducts in segment VIII due to an intraluminal lesion in the right hepatic duct, suggestive of intraductal cholangiocarcinoma.