AccScience Publishing / TD / Online First / DOI: 10.36922/TD025070011
CASE REPORT

An unusual case of malignant biliary tract obstruction

Sakditad Saowapa1* Chalothorn Wannaphut2 Hector Jose Garcia Pleitez1 Andrea Ortiz Maldonado1 Miriam Alicia Paz Sierra1 Natchaya Polpichai3 Pharit Siladech4 Meenu Sharma5 Lukman Tijani6
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1 Department of Internal Medicine, Texas Tech University Health Sciences Center at Lubbock, Lubbock, Texas, United States of America
2 Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, United States of America
3 Department of Internal Medicine, Louis A. Weiss Memorial Hospital, Chicago, Illinois, United States of America
4 Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
5 Department of Pathology, Texas Tech University Health Sciences Center at Lubbock, Lubbock, Texas, United States of America
6 Department of Hematology and Oncology, Texas Tech University Health Sciences Center at Lubbock, Lubbock, Texas, United States of America
Tumor Discovery, 025070011 https://doi.org/10.36922/TD025070011
Received: 11 February 2025 | Revised: 27 May 2025 | Accepted: 5 June 2025 | Published online: 25 June 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Abstract

Malignant biliary tract obstruction (MBTO) is most commonly associated with primary hepatobiliary and pancreatic malignancies. Here, we present a rare case of a 65-year-old female who developed obstructive jaundice, which initially raised suspicion for hepatobiliary carcinoma. Cross-sectional imaging, including computed tomography and magnetic resonance imaging, revealed hepatic lesions, and endoscopic retrograde cholangiopancreatography demonstrated a malignant biliary stricture. Histopathological analysis of a liver biopsy unexpectedly confirmed metastatic urothelial carcinoma (UC). Further evaluation with cystoscopy, prompted despite the absence of urinary symptoms, identified a small bladder mass, which was biopsy-proven as the primary UC. UC typically metastasizes to lymph nodes, lungs, or bones, and isolated liver involvement causing MBTO is exceptionally uncommon. This case underscores the importance of maintaining a broad differential diagnosis in patients with malignant biliary obstruction, as atypical metastatic patterns can mimic more common hepatobiliary cancers and delay appropriate management.

Keywords
Malignant biliary tract obstruction
Cholangiocarcinoma
Urothelial carcinoma
Hepato-pancreato-biliary cancer
Bladder cancer
Funding
None.
Conflict of interest
The authors declare they have no competing interests.
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Tumor Discovery, Electronic ISSN: 2810-9775 Print ISSN: 3060-8597, Published by AccScience Publishing