{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T02:03:29Z","timestamp":1784167409725,"version":"3.55.0"},"reference-count":27,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Cholangiocarcinoma (CCA) is a rare and aggressive malignancy of the biliary tree. Renal metastasis represents an exceptionally rare event, reported in fewer than 0.5% of cases. Its clinical and imaging presentation may closely mimic benign renal conditions, particularly renal infarction, posing a significant diagnostic challenge. Case Presentation: We report the case of a 72-year-old man who initially presented with intense right-sided flank pain without urinary symptoms. Combined imaging findings, including absent Doppler signal on ultrasound and absent contrast uptake on contrast-enhanced ultrasound (CEUS) in two-thirds of the right renal parenchyma, led to an initial diagnosis of right renal infarction. Seven months later, re-evaluation prompted by macroscopic haematuria, significant weight loss, cholestatic syndrome, and markedly elevated CA 19-9 revealed an invasive renal tumour mass associated with biliary ductal dilatation. Renal biopsy with immunohistochemical analysis (CK7+, PAX8\u2212, c-kit weakly positive) confirmed renal metastasis from extrahepatic cholangiocarcinoma. The patient\u2019s clinical course was complicated by acute cholangitis, Clostridioides difficile enterocolitis, and upper gastrointestinal haemorrhage, requiring endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting, endoscopic ultrasound (EUS)-guided hepaticogastrostomy, and endoscopic haemostasis. Conclusions: A systematic review of the published literature identified only two previous dedicated case reports of renal metastasis from CCA, making this, to our knowledge, the third such case and the first involving an extrahepatic primary tumour presenting through its renal metastasis. This case highlights the diagnostic pitfall of mistaking hypovascular renal metastasis for renal infarction, the indispensable role of immunohistochemistry, and the importance of early percutaneous biopsy in avascular renal lesions without a confirmed thromboembolic aetiology.<\/jats:p>","DOI":"10.3390\/diagnostics16142207","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T01:05:07Z","timestamp":1784163907000},"page":"2207","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Renal Metastasis from Extrahepatic Cholangiocarcinoma Mimicking Renal Infarction: A Case Report and Literature Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8327-2444","authenticated-orcid":false,"given":"Mirela-Georgiana","family":"Perne","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, 4th Medical Discipline, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4435-142X","authenticated-orcid":false,"given":"Olga Hilda","family":"Or\u0103\u0219an","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, 4th Medical Discipline, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4090-0164","authenticated-orcid":false,"given":"Cezara Andreea","family":"Gerdanovics","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, 4th Medical Discipline, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5087-9282","authenticated-orcid":false,"given":"Mircea Vasile","family":"Milaciu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, 4th Medical Discipline, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u0103lin Vasile","family":"Vlad","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, 4th Medical Discipline, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioan","family":"\u0218imon","sequence":"additional","affiliation":[{"name":"4th Surgical Department, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u0103zvan","family":"Tog\u0103nel","sequence":"additional","affiliation":[{"name":"4th Surgical Department, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolae Voicu","family":"Rednic","sequence":"additional","affiliation":[{"name":"Regional Institute of Gastroenterology and Hepatology \u201cProf. Dr. Octavian Fodor\u201d, 400394 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iuliana Georgiana","family":"\u021aifui","sequence":"additional","affiliation":[{"name":"Regional Institute of Gastroenterology and Hepatology \u201cProf. Dr. Octavian Fodor\u201d, 400394 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Elena","family":"Cornea","sequence":"additional","affiliation":[{"name":"Municipal Hospital Aiud, 515200 Aiud, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoleta Valentina","family":"Leach","sequence":"additional","affiliation":[{"name":"Department 2, Faculty of Nursing and Health Sciences, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Codru\u021ba Claudia Gherman","family":"Lencu","sequence":"additional","affiliation":[{"name":"Department 1, Fundamental Discipline, Endocrinology, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Victor Babe\u0219 Street, No. 8, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1926-6456","authenticated-orcid":false,"given":"Anamaria Vl\u0103du\u021ba","family":"Tomoiag\u0103","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, 4th Medical Discipline, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasile","family":"Negrean","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, 4th Medical Discipline, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2756-5784","authenticated-orcid":false,"given":"Teodora Gabriela","family":"Alexescu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, 4th Medical Discipline, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, Republicii Street, No. 18, 400015 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1038\/nrgastro.2011.131","article-title":"Clinical Diagnosis and Staging of Cholangiocarcinoma","volume":"8","author":"Blechacz","year":"2011","journal-title":"Nat. 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