A Case of Amyloid Deposit in the Glisson's Capsule Presenting with Intrahepatic Bile Duct Dilation

Masaaki Iwatsuki, Keiichiro Kanemitsu, Akira Chikamoto, Yoshifumi Baba, Hirohisa Okabe, Hiroshi Takamori, Toru Beppu, Masahiko Hirota, Kenichi Iyama* and Hideo Baba

Department of Gastroenterological Surgery and Department of Pathology*, Graduate School of Medical Sciences, Kumamoto University

A 67-year-old man diagnosed ten years earlier with systemic amyloidosis and suffering epigastric pain with fever was referred for evaluation of intrahepatic bile duct dilation. Percutaneous transhepatic cholangiography showd dilated bile duct in the left lateral segment. Cytology of the bile juice was class III. Although no definitive tumor-like lesion was detected in abdominal ultrasonography, computed tomography or magnetic resonance imaging, portgraphy showed a stricture of the left branch of the portal vain, necessitating left hepatectomy based on a diagnosis of intrahepatic cholangiocarcinoma. Histological examination showed no malignant cells in the epithelium of the bile ducts, but amorphous eosinophilic material stained with Congo red was found in the expanded Glisson's capsule. No amyloid deposit was seen along the sinusoidal wall. The definitive diagnosis was nonspecific cholangitis due to amiloid deposit in Glisson's capsule.

Key words
amyloidosis, intrahepatic bile duct dilation, Glisson's capsule

Reprint requests
Masaaki Iwatsuki Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
1-1-1 Honjo, Kumamoto, 860-8556 JAPAN

Accepted
December 19, 2007

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