oriental cholangitis

[pak001]

Left lobectomy 10 years ago due to oriental cholangitis. Recent CT scan and PET scan results:  "concern for malignancy" in caudate lobe and segment 5.  Ultra-sound guided biopsy was negative for malignancy, but moderate portal inflammation.  PET SUV of lesion 6.1 and one lymph node 4.3.   MD wants second biopsy done, this time CT scan guided.  Can the disease of cholangitis cause increased SUV on PET?  On CT and PET scans, how does inflammation appear?   Is is easily distinguishable, between inflammation and malignancy of liver?
Liver function tests ALL normal, CA 19- less than 2.   CEA  was 8.3.  AFP WAS WNL.  CA 125 WNL.
PET scan shows lesion to be 5 cm x 3 cm in the caudate extending to segment 5.  If it was cancer, can someone have tumor this size and still be asymptomatic with normal lab results???  Please help.

[Thomas D Schiano, MD]

this could be a tumor but in this area could be a regnerative nodule also, even to this size.  One could definitely be asymptomatic with this being a tumor but my gut sense is that this is not.  After a resection the anatomy could be distorted somewhat.  unfortunately i think another biopsy may be warranted.  make sure that an expert livr pathologist is reading the biopsy--they may also need a second opinion of the reading

[Thomas D Schiano, MD]

i think the laparoscopic approach frankly would be best if the surgeon feels that it is feasible in the setting of your previous resection.  The PET findings are not typical for a regenerative nodule nor is the histology but in the setting of oriental cholangiohepatitis and chronic inflammation, these may still be possible. Please let me know what transpires.

[pak001]

Due to the location of the lesion, Caudate/segment 5, would you feel CT scan guided biopsy would be adequate or would you recommend laporoscopy biopsy?
Also,  the location of the caudate and segment 5, is that along the border of the left lobectomy?

Thanks so much for taking time to answer questions. You must be very busy, but you taking time to answer questions really helps people like us.

[pak001]

Could a regenerative nodule show positive uptake on PET scan as well?
Also, could it cause inflammation of portal area and cause CEA  level increase due to inflammation?
CT scan also showed bile duct dilation as well.

Thanks so much for your response Dr. Schiano. Very much appreciate it.