SHM Converge Scientific Abstract ePoster Gallery-A Mass of Questions

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This case describes a 35-year-old woman with severe upper abdominal pain, weight loss, and a large left hepatic mass found on CT. Her labs showed elevated alkaline phosphatase and markedly elevated CA 19-9, with otherwise normal results. MRI demonstrated multiple cystic-appearing masses with inflammatory changes in the left liver lobe. Because of the patient’s age, acute symptoms, and occupational exposure as a dog groomer, the initial differential included pyogenic liver abscess, cystic echinococcosis, and malignancy.<br /><br />Her family history was highly concerning for Lynch syndrome, with ovarian cancer in her mother, uterine cancer in her grandmother, and colon cancer in her grandfather. Although intrahepatic cholangiocarcinoma (IHC) is uncommon in Lynch syndrome, it can occur as an extracolorectal cancer. IHC is often asymptomatic early on and may present later with obstructive symptoms such as jaundice, pale stools, and dark urine.<br /><br />Further workup included negative CT chest/abdomen/pelvis, negative EGD and colonoscopy, and ultimately percutaneous aspiration and biopsy confirming intrahepatic cholangiocarcinoma. She was discharged with oncology follow-up in another state, where she had more family support.<br /><br />The case emphasizes the importance of a detailed history, including family and occupational exposures, when evaluating a liver mass in a young patient. It also highlights the need to consider malignancy-associated syndromes such as Lynch syndrome, especially when personal or family cancer histories suggest inherited risk.

Asset Subtitle

Matthew Agnew

Meta Tag

Author List Jane Pearce, Jeeva Jacob, Kristina Neri, Matthew Agnew, William C. Lippert

Category Clinical Vignettes

Concept Intrahepatic Cholangiocarcinoma

Concept Lynch Syndrome

Concept Cholangiocarcinoma

Concept Diagnostic Confirmation

Concept Diagnostic Criteria

Distinguished Non-Finalist

Presenter Organization Wake Forest Baptist Health

Presenting Author Matthew Agnew

Track Adult

Keywords

intrahepatic cholangiocarcinoma

Lynch syndrome

liver mass

CA 19-9

hepatic cystic lesions

pyogenic liver abscess

cystic echinococcosis

occupational exposure

family history of cancer

cholestatic liver enzymes

Intrahepatic Cholangiocarcinoma

Lynch Syndrome

Cholangiocarcinoma

Diagnostic Confirmation

Diagnostic Criteria