Two Cases of Primary Sclerosing Cholangitis

Masayuki Tori, Masaaki Nakahara, Hiroki Akamatsu, Shin Mizutani, Katsuhide Yoshidome, Shigeyuki Ueshima, Kazuyasu Nakao and Masahiko Tsujimoto*

Department of Surgery and Department of Pathology*, Osaka Police Hospital

Primary sclerosing cholangitis (PSC) is classified according to lesion site into a diffuse type and a localized type, and it is often difficult to accurately diagnose and appropriately treat either of them. We recently encountered and successfully operated two cases of localized-type PSC. Case 1 was in a 37-year-old man with localized-type PSC. During examinations for gallbladder polyps, diagnostic imaging revealed dilatation of the bile ducts in the left hepatic lobe. Since the possibility of malignancy could not be ruled out, the left hepatic lobe and the caudate lobe were resected. Histopathological examination of the resected specimen indicated PSC alone, with no evidence of malignancy. Case 2 was in a 63-year-old man with localized-type PSC. His chief complaints were weight loss and jaundice. Diagnostic imaging, including CT scanning, disclosed a tumor in the porta hepatis, and cytological examination of bile obtained during percutaneous transhepatic bile drainage (PTBD) revealed class V in cytology. Based on a preparative diagnosis of cholangiocellular carcinoma, we performed extended right hepatic lobectomy, and in both cases the postoperative course was favorable without any evidence of recurrence. We concluded that operative management should be actively considered for patients with localized-type PSC.

Key words
sclerosing cholangitis, cholangioma, direct cholangiogram

Reprint requests
Masayuki Tori Department of Surgery, Osaka Police Hospital
10-31 Kitayama-cho, Tennouji-ku, Osaka, 543-0035 JAPAN

Accepted
July 27, 2005

To read the PDF file you will need Abobe Reader installed on your computer.