title: Management of an unclear bile duct stenosis.
abstract: It is frequently difficult to determine whether a bile duct stricture is benign or harbors a malignant tumor based on medical history alone. Therefore, cholestasis of unknown etiology requires a thorough diagnostic evaluation to make a definitive diagnosis and choose the best course of treatment for the patient. We report the case of a 42-year-old man who developed cholestasis 6 years after undergoing orthotopic liver transplantation for end-stage liver disease. The bile duct was dilated by interventional endoscopy, and a brush cytology was obtained. Cytology revealed an inflammatory reaction. Three months later, the stricture persisted. We performed a forceps biopsy, and the diagnosis of a cholangiocarcinoma was confirmed histologically. We conclude that a combined application of brush biopsy/forceps biopsy and endoscopic measures is essential in cases of bile duct strictures of unknown etiology. Occasionally, surgical confirmation may be required. In any case, a single brush cytology is insufficient for diagnosis.
authors.affiliation: Department of Surgery, University of Hamburg, Martinistrasse 52, D-20246 Hamburg, Germany. langwieler@uke.uni-hamburg.de
authors.forename: T E
authors.initials: TE
authors.lastname: Langwieler
authors.forename: J S
authors.initials: JS
authors.lastname: Kim
authors.forename: O
authors.initials: O
authors.lastname: Mann
authors.forename: F
authors.initials: F
authors.lastname: Thonke
authors.forename: W T
authors.initials: WT
authors.lastname: Knoefel
authors.forename: X
authors.initials: X
authors.lastname: Rogiers
authors.forename: J R
authors.initials: JR
authors.lastname: Izbicki
mesh_terms: D000328:Adult; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D001706:Biopsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D018281:Cholangiocarcinoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D002761:Cholangitis / Q000175:diagnosis*; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology*; D002780:Cholestasis, Intrahepatic / Q000209:etiology*; D003584:Cytological Techniques; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004724:Endoscopy; D005188:False Negative Reactions; D017809:Fatal Outcome; D006519:Hepatitis, Alcoholic / Q000150:complications; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D009366:Neoplasm Seeding; D010534:Peritoneal Neoplasms / Q000175:diagnosis / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D015607:Stents; D013525:Surgical Instruments