A160 A SARCOMATOID CARCINOMA OF THE COMMON BILE DUCT PRESENTING AS PAINLESS JAUNDICE AND EXTRAHEPATIC BILIARY OBSTRUCTION

Abstract Background Sarcomatoid carcinomas are extremely rare tumors made of epithelial and mesenchymal elements. They have been found in various organs, but presence the common bile duct (CBD) has only reported a handful times. Insight regarding clinical history, histopathology, treatment, prognosis is limited. The majority CBD sarcomatoid occurred elderly women, including this case. Surgical resection mainstay treatment roles for chemotherapy radiation therapy undetermined. Prognosis variable, generally poor. Purpose Additional information will aid establishing timely diagnosis may alter options prognosis. We aim to add limited literature surrounding neoplasm. Method A 71-year-old female presented with painless jaundice, decreased appetite, weight loss. Initial investigations showed an alkaline phosphatase (ALP) 3075 U/L, aspartate transaminase (AST) 507 alanine aminotransferase (ALT) 298 total bilirubin 325.5 µmol/L, direct 254.1 µmol/L. computed tomography (CT) scan done marked intra- extrahepatic biliary ductal dilation appropriate tapering distal hyperdensity. Tissue biopsy obtained by endoscopic retrograde cholangiopancreatography (ERCP) was suspicious malignant peripheral nerve sheath tumor. differential also included synovial sarcoma mesothelioma. Result(s) After multidisciplinary discussion involving hepatobiliary surgery, medical oncology, pancreaticoduodenectomy performed; there no role neoadjuvant/adjuvant chemotherapy/radiation therapy. Final pathology revealed well circumscribed mass narrow attachment posterior CBD, measuring 5.6 x 3.2 2.8 cm. Immunohistochemistry mixed differentiation sarcomatoid, squamous, glandular components, consistent carcinoma. H3K27me3 expression lost neoplastic cells. Immunostaining strong vimentin weak CD34, calretinin, CK5 EMA. Post-operative course complicated pancreaticojejunal leak, surgical wound infection, myocardial injury, esophageal stricturing. 14-weeks post-pancreaticoduodenectomy patient C.difficile infection perforated viscus, exact location which not visible on imaging. Emergent laparotomy gastroduodenal leak diffuse small bowel ischemia. passed away shortly after emergent surgery. Conclusion(s) This case illustrates presentation carcinoma within highlights some diagnostic challenges, management strategies, complications, potential poor disease. Further research required guide management, ultimately improve outcomes. Please acknowledge all funding agencies checking applicable boxes below None Disclosure Interest Declared