A Case Report of Primary Sclerosing Cholangitis Causing Difficulties in Differetiatial Diagnosis from Hilar Cholangiocarcinoma

Hitoshi Inagaki, Tsuyoshi Kurokawa¹⁾, Hiroshi Kojima, Junji Kato, Taiki Kojoma, Yasunobu Fujimitsu, Takanori Matsui, Junichi Sakamoto²⁾ and Toshiaki Nonami¹⁾

Department of Surgery, Aichi Prefectural Hospital, ¹⁾Department of Surgery, Aichi Medical University, ²⁾Department of Epidemiological and Clinical Research Information Management, Kyoto University, Graduate School of Medicine

We report a case of localized primary sclerosing cholangitis (PSC) mimicking hilar cholangiocarcinoma. A 57-year-old male with elevated serum bilirubin in blood biochemistry examinations who underwent percutaneus transhepatic cholangiodrainage to alleviate jaundice was hospitalized with a diagnosis of hilar cholangiocarcinoma. Cholangiography showed dilation of the left and right intrahepatic bile ducts and stenosis extending to the bifurcation of the left and right hepatic bile duct from the common hepatic duct. Angiography showed slight encasement of the right hepatic artery. We diagnosed hilar cholangiocarcioma in radioimaging and resected the right lobe and caudate lobe of the liver on 14 days after percutaneus intrahepatic right portal vein embolization. Pathologically, no malignant cells were detected and only a thickened fibrous layer around the bile duct and infiltration of inflammatory cells into hepatic tissue were found. The final diagnosis of PSC was determined based on the absence of biliary disease history. PSC is difficult to differentially diagnose from cholangiocacinoma, especially in patients who have localized biliary stenosis in the hepatic hilar region, as in our case. PSC is progressive and involves a high risk of complicating cholangiocarcinoma. It is, therefore, necessary to carefully use several modalities for diagnosis and treatment of such localized biliary stenosis.

Key words
primary sclerosing cholangitis, bile duct cancer

Reprint requests
Hitoshi Inagaki Department of Surgery, Aichi Prefectural Hospital 18 Kuriyado, Kakemachi, Okazaki-shi, 444-0011 JAPAN

Accepted
February 26, 2003

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