Cholangiocellular carcinoma associated with liver cirrhosis and recurrent esophageal variceal bleeding: a clinical case

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Abstract

Background. Cholangiocarcinoma is a rare primary liver malignancy accounting for 10–15 % of hepatic cancers. Diagnosis of this condition in the setting of cirrhosis is challenging and is often established posthumously.

Clinical case. A 47-year-old male patient with chronic alcohol abuse and hepatitis C seropositivity presented with acute upper gastrointestinal bleeding on March 18, 2025. Child–Pugh class B cirrhosis, portal hypertension, and esophageal varices (grade II–III) were diagnosed. Ultrasonography showed multiple focal liver lesions suggestive of malignancy. The patient failed to comply with oncology consultation and continued his previous lifestyle. Over the subsequent 7-month period, the patient experienced four episodes of massive variceal hemorrhage requiring intensive hemostatic therapy and massive blood transfusions. Successful endoscopic variceal ligation was performed during the third admission. Death occurred during the fourth hemorrhagic episode (October 4, 2025). Autopsy and histopathological examination revealed cholangiocarcinoma of the intrahepatic bile ducts (International Classification of Diseases 10 (ICD-10) code C22.1) with multiple hepatic metastases on a background of mixed-etiology micro-macronodular cirrhosis (hepatitis C virus + chronic alcohol intoxication).

Conclusion. This case illustrates diagnostic challenges of detecting cholangiocarcinoma in cirrhotic patients, progressive severity of recurrent variceal hemorrhages, and natural progression of untreated disease. It emphasizes the importance of active cancer surveillance, morphological verification, and the high effectiveness of endoscopic variceal ligation.

About the authors

Aleksey V. Dedov

Astrakhan State Medical University, Ministry of Health of Russia

Author for correspondence.
Email: dedov1965.d@yandex.ru
ORCID iD: 0000-0003-4806-0144

Department of Propaedeutics of Internal Diseases

Russian Federation, 121 Bakinskaya St., Astrakhan, 414000

Yu. N. Sikorskaya

S. M. Kirov City Clinical Hospital No. 3

Email: dedov1965.d@yandex.ru

Gastroenterology Department

Russian Federation, 2 Khibinskaya St., Astrakhan, 414038

M. R. Bekov

S. M. Kirov City Clinical Hospital No. 3

Email: dedov1965.d@yandex.ru

Surgery Department No. 1

Russian Federation, 2 Khibinskaya St., Astrakhan, 414038

A. V. Savishchev

Astrakhan State Medical University, Ministry of Health of Russia

Email: dedov1965.d@yandex.ru

Department of Pathological Anatomy

Russian Federation, 121 Bakinskaya St., Astrakhan, 414000

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