CHOLANGIOCARCINOMA: CLINICAL AND LABORATORY TECHNIQUES WITH SPECIAL EMPHASIS ON IMAGING TECHNOLOGIES

Biljana Prgova; Sandra Dejanova; Biljana Bozinovska; Masa Kostova; Gordana Bozinovska-Beaka; Dimitar Veljanovski; Martin Nedelkoski

Biljana Prgova PHI City General Hospital "8-mi Septemvri",University Clinic of Radiology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, North Macedonia
Sandra Dejanova PHI City General Hospital "8-mi Septemvri, Skopje, University Clinic of Radiology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, North Macedonia
Biljana Bozinovska PHI City General Hospital "8-mi Septemvri", North Macedonia
Masa Kostova PHI City General Hospital "8-mi Septemvri",University Clinic of Radiology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, North Macedonia
Gordana Bozinovska-Beaka PHI City General Hospital "8-mi Septemvri", Skopje, Faculty of Medical Sciences, Goce Delcev University, Stip, North Macedonia
Dimitar Veljanovski PHI City General Hospital "8-mi Septemvri",University Clinic of Radiology, Faculty of Medicine, Ss Cyril and Methodius University in Skopje, North Macedonia
Martin Nedelkoski Clinical Hospital “Dr. Trifun Panovski”, Bitola, North Macedonia

Abstract

Cholangiocarcinoma is a rare and highly aggressive malignancy of the biliary epithelium, marked by considerable anatomical heterogeneity and a largely nonspecific clinical presentation, factors that frequently contribute to delayed diagnosis. The purpose of this study was to examine the demographic, clinical, laboratory and imaging characteristics of patients with cholangiocarcinoma and to assess their relationship with imaging-based anatomical tumor classification. This retrospective study included 40 adult patients with histopathologically confirmed cholangiocarcinoma diagnosed in General Hospital “8th September” in Skopje, Republic of North Macedonia, between January 2022 and December 2025. Clinical presentation, hepatobiliary laboratory parameters, and imaging findings obtained using contrast-enhanced computed tomography, and most often magnetic resonance imaging with magnetic resonance cholangiopancreatography were reviewed. Based on imaging findings, tumors were classified as intrahepatic, perihilar, or distal cholangiocarcinoma. The study population demonstrated a male predominance (62.5%), with a mean age at diagnosis of approximately 68 years. Perihilar cholangiocarcinoma was the most commonly identified type (55%), followed by distal (27.5%) and intrahepatic tumors (17.5%). Jaundice and pruritus occurred exclusively in patients with extrahepatic disease, whereas all asymptomatic patients had intrahepatic tumors. Laboratory analysis revealed a marked cholestatic pattern in perihilar and distal cholangiocarcinoma, with substantially higher bilirubin, alkaline phosphatase, and gamma-glutamyl transferase levels compared with intrahepatic disease. Overall, these findings highlight the importance of anatomical tumor classification and support the integrated use of imaging (MR and MRCP), clinical assessment, and laboratory data in the diagnostic evaluation of cholangiocarcinoma.

Keywords: Cholangiocarcinoma; Biliary tract neoplasms; Magnetic resonance cholangiopancreatography.

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