Case history :

• 66 year old man
• Social alcoholism and diabetes
• Since 4 months :
  • fluctuating painless jaundice
  • loss of weight : 18 kgs
• Laboratory findings :
  • total bilirubin: 1,3 mg/dl
  • transaminases normal
  • alkaline phosphatases : 3 times normal
  • GGT: 1070 IU ( N < 35)
  • CA 19.9: 70 U/ml
• ERCP
• CT scan
• Brush cytology
• Biopsy

Which is your diagnosis ?

• ADENOCARCINOMA
• CHOLANGIOCARCINOMA
• METASTASIS
• ENDOCRINE TUMOR