Immunoglobulin G4-related sclerosing cholangitis mimicking hilar cholangiocarcinoma diagnosed with following bile duct resection: report of a case

International Surgery
Atsushi MikiYoshikazu Yasuda

Abstract

We report a rare case of immunoglobulin G4 (IgG4)-related sclerosing cholangitis without other organ involvement. A 69-year-old-man was referred for the evaluation of jaundice. Computed tomography revealed thickening of the bile duct wall, compressing the right portal vein. Endoscopic retrograde cholangiopancreatography showed a lesion extending from the proximal confluence of the common bile duct to the left and right hepatic ducts. Intraductal ultrasonography showed a bile duct mass invading the portal vein. Hilar bile duct cancer was initially diagnosed and percutaneous transhepatic portal vein embolization was performed, preceding a planned right hepatectomy. Strictures persisted despite steroid therapy. Therefore, partial resection of the common bile duct following choledochojejunostomy was performed. Histologic examination showed diffuse and severe lymphoplasmacytic infiltration, and abundant plasma cells, which stained positive for anti-IgG4 antibody. The final diagnosis was IgG4 sclerosing cholangitis. Types 3 and 4 IgG4 sclerosing cholangitis remains a challenge to differentiate from cholangiocarcinoma. A histopathologic diagnosis obtained with a less invasive approach avoided unnecessary hepatectomy.

References

Aug 1, 1985·The British Journal of Surgery·N S HadjisL H Blumgart
Jul 16, 1999·Lancet·G W ErkelensS D van der Werf
Jan 3, 2001·The British Journal of Surgery·M F GerhardsD J Gouma
Mar 10, 2001·The New England Journal of Medicine·H HamanoK Kiyosawa
May 2, 2002·Journal of Gastroenterology and Hepatology·Toshihiko HigashizawaKentaro Sugano
Jun 19, 2004·Hepatology Research : the Official Journal of the Japan Society of Hepatology·Hajime TakikawaYasuni Nakanuma
Jan 6, 2005·Pancreas·Takayoshi NishinoKeiko Shiratori
Jul 18, 2006·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Suresh T ChariMichael B Farnell
Nov 7, 2006·Surgery·Chandrakanth AreWilliam R Jarnagin
Dec 22, 2006·The New England Journal of Medicine·Dmitry L FinkelbergWilliam R Brugge
Jan 29, 2008·Gastroenterology·Amaar GhazaleMichael B Farnell
Feb 21, 2008·World Journal of Gastroenterology : WJG·Andreas WeberChristian Prinz
Oct 1, 2010·Hepatology Research : the Official Journal of the Japan Society of Hepatology·Takeo FujitaTaira Kinoshita
Sep 29, 2011·Journal of Gastroenterology·Takahiro NakazawaTakashi Joh
Feb 1, 2012·Japanese Journal of Clinical Oncology·Masahiro Maeda, Kazuaki Shimada
Jun 22, 2012·Journal of Hepato-biliary-pancreatic Sciences·Hirotaka OharaUNKNOWN Japan Biliary Association
Jan 25, 2013·International Surgery·Norio KuboHiroyuki Kuwano
Feb 19, 2013·Journal of Gastroenterology·Kazuichi OkazakiMakoto Takaoka

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Citations

Jul 22, 2016·Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology·Kamal Sunder YadavP Jagannath
Jan 13, 2016·Journal of Pathology and Translational Medicine·Seokhwi KimKee-Taek Jang
Jan 21, 2017·Molecular and Clinical Oncology·Karin E KoopmanMichael Klemt-Kropp

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Methods Mentioned

BETA
biopsy
dissect

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