alexa Metastatic Lung Cancer to the Common Bile Duct Presenting as Obstructive Jaundice | OMICS International
ISSN: 2475-3181
Journal of Hepatology and Gastrointestinal disorders

Like us on:

Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Metastatic Lung Cancer to the Common Bile Duct Presenting as Obstructive Jaundice

Cochrane J*

University of Washington, Spokane, Washington, USA

*Corresponding Author:
Justin Cochrane
University of Washington
Spokane, Washington, USA
E-mail: [email protected]

Received date: February 27, 2016; Accepted date: March 15, 2016; Published date: March 22, 2016

Citation: Cochrane J (2016) Metastatic Lung Cancer to the Common Bile Duct Presenting as Obstructive Jaundice. J Hepatol Gastroint Dis 2:121. doi:10.4172/2475-3181.1000121

Copyright: © 2016 Cochrane J. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Hepatology and Gastrointestinal disorders


Context: Lung cancer is the second most common cancer amongst men and women. Metastatic spread of lung cancer usually involves adrenal glands, bone, brain, liver, and other portions of the lung. The biliary system is rarely affected by metastatic lung cancer via hematogenous spread.

Case: We present a case of 61-year old female who presented with obstructive jaundice secondary to a mass in the common bile duct near the takeoff of the cystic duct. EUS/FNA via rapid cytology identified the mass as an adenocarcinoma initially thought to be cholangiocarcinoma. However, with Immunohistochemical staining was identified as metastatic lung adenocarcinoma.

Conclusion: This is case is one of three reported in the literature with direct metastasis of lung cancer to the common bile duct. Patients with obstructive jaundice secondary to CBD mass and known distant primary cancer should be considered for EUS with FNA and immunohistochemical staining to determine the underlying source of CBD mass.


Metastatic lung cancer; Common bile duct mass


Lung cancer is the second most common cancer among both men and women accounting for 27% of all cancer deaths [1]. Adrenal gland, bone, brain, liver, and other portions of the lung are common sites of metastatic lung cancer. Biliary involvement of lung cancer has a less than 1% incidence [2]. Involvement of the intrahepatic and extra hepatic ducts is demonstrated via several mechanisms. First is involvement of direct extension of metastatic lung cancer from the liver into the bile duct. Second is the compression or erosion of metastatic lymph nodes in the retroperitoneum or porta hepatis into the bile duct. Finally metastatic lesion in the head of the pancreas causes direct compression or extension into the distal common bile duct (CBD). A rare etiology is hematogenous metastasis to the interior lumen of the CBD. Only two cases reported in the literature of hematogenous metastatic involve the CBD lumen [2,3]. We present the third case of metastatic lung cancer to the common bile duct presenting as abdominal distention and jaundice.


A 61-year-old Caucasian female presented with dry cough for 2 months, worsening shortness of breath, abdominal pain, distention, and jaundice. Prior to admission a chest computer tomography (CT) demonstrated a right upper lobe nodule measuring 2.6 cm × 2 cm, right pleural effusion, and lymphadenopathy in the right paratracheal, superior mediastinum, subcarinal and hilar areas (Figure 1). Cytology from the thoracentesis of the right pleural effusion demonstrated cells suspicious for adenocarcinoma with confirmation of primary lung adenocarcinoma through immunohistochemical staining positive for cytokeratin, Napsin A and thyroid transcription factor (TTF-1).


Figure 1: Lung nodule and right pleural effusion on CT chest prior to admission.

On admission she described her abdominal pain as fullness with a constant pressure throughout her abdomen. She stated that this made her breathing worse over the past couple of weeks. Physical exam demonstrated scleral icterus bilaterally, coarse breath sounds bilaterally in all lung fields, and abdominal distention with no visible fluid wave. Her liver enzymes were ALP 726 U/L, ALT 165 U/L, AST 135 U/L, and total bilirubin 11.6 mg/dL. Cancer antigen 19-9 of 5073 U/mL. CBC and BMP were normal. Magnetic Resonance Cholangiopancreatography (MRCP) demonstrated a dilated CBD measuring 0.9 cm with narrowing of the CBD at the pancreatic head (Figure 2).


Figure 2: MRCP demonstrating CBD dilation in coronal view.

Due to narrowing of the CBD, an endoscopic ultra sound (EUS) was undertaken for evaluation of the obstruction of the CBD. EUS identified a thickened CBD measuring 7.1 mm with a lumen diameter of 1.6 mm and a hypoechoic mass of 15.8 mm × 11.3 mm near the takeoff of the cystic duct (Figure 3). EUS also demonstrated multiple areas of lymphadenopathy: peripancreatic 10.8 mm × 6.5 mm and 10.6 mm × 3.8 mm, perigastric 6.3 mm × 3.3 mm and 6.5 mm × 4.7 mm, celiac axis 11.6 mm × 7.4 mm.


Figure 3: EUS demonstrating mass in the CBD adjacent to cyst duct take off measuring 15.8 mm × 11.3 mm.

No lymph nodes where in direct contact with the biliary system. Fine needle aspiration was undertaken for cytology and cellblock of the CBD mass. Rapid cytology demonstrated adenocarcinoma. Endoscopic Retrograde Cholangiopancreatography (ERCP) demonstrated a long stricture of the entire CBD and 10 mm × 60 mm uncovered self-expanding metal stent was placed across the obstruction with good biliary drainage noted after placement (Figure 4). Final pathology and immunohistochemical staining revealed cytokeratin and TTF-1 confirming a metastatic lung adenocarcinoma into the CBD.


Figure 4: ERCP demonstrating stricture in the CBD.


Malignant masses associated with CBD are most commonly cholangiocarcinoma which accounts for 2% of all cancers [4]. Primary cancer rarely metastasizes to the CBD but when this occurs, hepatocellular carcinoma, colon cancer, and breast are the most common primary sites. Metastatic lung cancer to the CBD has a less than 1% incidence with the majority of cases reported being small cell lung cancer [5-9]. Only two cases of primary lung adenocarcinoma with hematogenous metastasis to the CBD are described in the literature [2,3]. To our knowledge this is only the third reported case of lung adenocarcinoma metastasizing to the bile duct with subsequent development of obstructive jaundice.

Our diagnosis was made via FNA of the CBD mass via a 19-gauge core needle with EUS. Histopathology revealed adenocarcinoma and in association elevated CA 19-9 greater than 129 U/ml, carried 98% specificity for cholangiocarcinoma [4]. Therefore the initial diagnosis was believed to be a double primary cancer; lung adenocarcinoma and cholangiocarcinoma. However, given that our patient had a known lung adenocarcinoma with metastatic involvement of the pleural space, immunohistochemical staining was undertaken to determine the true etiology of the CBD mass before definitive treatment was decided upon.

The difficulty in making a diagnosis from hematoxylin-eosin staining alone arises from the fact that cholangiocarcinoma derives from epithelial lining in the biliary tract and 95% are adenocarcinoma in origin [1,4]. Immunohistochemical staining allows for further clarification between primary and metastatic adenocarcinoma by identifying specific feature of primary lung adenocarcinoma. Several immunohistochemical stains are available to determine primary adenocarcinoma of lung origin such as; cytokerin, Napsin A, and TTF- [1]. TTF-1 is a nuclear protein that plays a role in transcriptional activation during embryogenesis in the respiratory epithelium [3]. Roh et al. [10] demonstrated that TTF-1 has a specificity of 95% for metastatic lung cancer. By utilizing specific immunochemical stains, such as TTF-1, we were able to determine that in fact this CBD mass was not a primary cholangiocarcinoma but a metastatic lesion from primary lung adenocarcinoma. By establishing this diagnosis we were able to tailor a palliative chemotherapy treatment program in association with palliative stenting of the CBD with an uncovered selfexpanding metal stent; thus giving the patient the best quality of life with minimal intervention.

Patients with a known primary adenocarcinoma who present with obstructive jaundice from a CBD mass need EUS with FNA and immunohistochemical staining to determine the underlying etiology. Differentiating between double primary cancer and lung adenocarcinoma metastasis to the CBD is imperative to provide patients with the least invasive therapy possible.


Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Recommended Conferences

Article Usage

  • Total views: 9733
  • [From(publication date):
    March-2016 - Aug 19, 2018]
  • Breakdown by view type
  • HTML page views : 9634
  • PDF downloads : 99

Review summary

  1. Oliver Jackson
    Posted on Oct 20 2016 at 2:22 pm
    This is an interesting case report that describes lung cancer with CBD metastasis causing obstructive jaundice. Cases of obstructive jaundice needs to studied in reference with the serum direct/indirect bilirulin, urine bilirubin/urobilirugen and CBC.

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2018-19
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri & Aquaculture Journals

Dr. Krish

[email protected]

+1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A


[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals


porn sex

[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

Gaziantep Escort

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A


[email protected]

1-702-714-7001Extn: 9037


James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

mp3 indir

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals


Nimmi Anna

[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T


[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001Extn: 9042

© 2008- 2018 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
Leave Your Message 24x7