Anna Giulia Bottaccioli, Natale Porta, Piero Maceroni, Marco Maceroni, Jessica Cacciotti, Cesare Alessandri, Carlo Della Rocca, Andrea Laghi and Vincenzo Petrozza
Background: Cholangiocarcinoma (CCA) is a malignant epithelial cancer of the biliary tract characterized by late diagnosis and poor outcomes. We report the case of a young healthy caucasian male patient who presented with non-specific symptoms, normal blood tests and atypical radiological findings of CCA. Case presentation: A 30-years-old Caucasian man, employed as welder in a yacht components factory, without known risk factor for CCA, was admitted because of acute upper abdominal pain, nausea and vomiting. Patient’s medical history was significant only for heroin abuse treated with methadone maintenance therapy. Imaging findings on Computed Tomography and Magnetic Resonance of the abdomen showed multiple intrahepatic lesions of undetermined nature. The biopsy of hepatic lesions finally revealed an intrahepatic cholangiocarcinoma. Conclusion: Although there is no case described in literature of CCA due to opioid consumption, hepatotoxic Heroin and Methadone exposition may have exerted a role on cholangiocytes proliferation, increasing proinflammatory and mutagenic stimuli and down-regulating local pro-apoptotic factors, leading ultimately to CCA development in this young patient.
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