The biopsy results brought back his lost smile.

A 25-year-old male presented with high-grade intermittent fever of 2 months duration and progressively increasing   jaundice of  1 month .It was associated with anorexia and significant loss of weight.

His past and family history were not contributory. The examination displayed deep jaundice, no features of chronic liver disease and mild hepatomegaly.

After baseline investigations  contrast enhanced CT scan of abdomen done showed hypo dense mass lesion at porta hepatic causing biliary obstruction with dilated intrahepatic biliary radicals.There was encasement of the portal vein, superior mesenteric vein, superior mesenteric artery and inferior vena cava.A diagnosis of unresectable cholangiocarcinoma was suggested. Tumor marker CA19-9 was raised 89 U/ mL (normal: <37 U/mL).

 Surgery consultation was taken but the tumor was inoperable due to its vascular invasion. There is a limited role of chemotherapy in this condition

That evening  I had a detailed discussion with the family regarding his poor outcome.

Fine needle aspiration (FNAC) was done  from the mass lesion .

There was not an iota of suspicion in diagnosis ( obstructive Jaundice, weight loss and Tumor on CT) but to our great surprise patient turned out to have Tuberculosis of bile ducts completely treatable disease. (AFB positive, caseating granulomas)

This U turn in diagnosis was a great delight to the treating team.

We saw him recovering on ATT , thus biopsy brought back his lost smile.

He gained weight and his  Jaundice regressed and finally he lived happily thereafter.

Never be reluctant in providing the consent for biopsy when your doctor advises so.