A case report documents an association between intrahepatic cholangiocarcinoma and small-duct primary sclerosing cholangitis in a patient with Crohn disease, suggesting new surveillance needs.
Small-duct primary sclerosing cholangitis (sd-PSC) is traditionally regarded as a milder variant of PSC with a lower risk of hepatobiliary malignancy. Its association with intrahepatic cholangiocarcinoma (iCCA) remains unexplored. A 61-year-old woman with newly diagnosed Crohn disease presented with weight loss, anemia, and a liver mass initially suspected as hepatocellular carcinoma; biopsy confirmed poorly differentiated iCCA (CK7+/CK19+/Arginase-). MRCP showed normal large ducts with focal intrahepatic dilatation; liver biopsy demonstrated periductal onion-skin fibrosis diagnostic of sd-PSC. This report documents the first instance of metastatic iCCA in sd-PSC–CD, challenging current hepato-biliary malignancy surveillance paradigms in patients with inflammatory bowel disease.
No takes yet. Share an insight, caveat, or question.
Agrawal et al. (2026) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: