title: A case of benign bile duct stricture causing difficulty in differential diagnosis from bile duct carcinoma.
abstract: We report a patient with benign bile duct stricture causing difficulty in differential diagnosis from bile duct carcinoma. A 66-year-old woman consulted a local physician because of general fatigue. Blood biochemical tests showed increased levels of biliary tract enzymes. Abdominal ultrasonography (US) revealed tapering and blockage of the midportion of the bile duct and dilation of the intrahepatic bile ducts. Magnetic resonance cholangiopancreatography (MRCP) demonstrated obstruction of the midportion of the bile duct. Later, because a marked increase in biliary tract enzymes and jaundice appeared, percutaneous transhepatic biliary drainage (PTBD) was performed. Post-PTBD cytological examination of bile was negative for cancer. A third biopsy showed slight hyperplasia with no malignant findings. Recholangiography, performed through PTBD, suggested gradual improvement of bile duct stricture, but could not completely exclude the possibility of malignancy; thus, resection of the bile duct including the stricture site was performed, and the resected specimen was submitted for intraoperative frozen section examination. Histopathological diagnosis did not reveal malignant findings. After cholecystectomy and bile duct resection, hepaticojejunostomy (Roux-en-Y) was performed. Because only erosion and desquamation of the mucosal epithelium and mild submucosal inflammatory cell infiltration and fibrosis were observed, chronic cholangitis was diagnosed histopathologically. Surgical resection of the bile duct should be considered for potentially malignant stricture of the bile duct.
authors.affiliation: Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011, Fukuoka, Japan.
authors.forename: Hisafumi
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Jun
authors.initials: J
authors.lastname: Nagashima
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Kazunori
authors.initials: K
authors.lastname: Nishimura
authors.forename: Takahito
authors.initials: T
authors.lastname: Kodama
authors.forename: Hideki
authors.initials: H
authors.lastname: Matsuo
authors.forename: Shigeru
authors.initials: S
authors.lastname: Hamada
authors.forename: Masafumi
authors.initials: M
authors.lastname: Yasunaga
authors.forename: Masaharu
authors.initials: M
authors.lastname: Odo
authors.forename: Shuichi
authors.initials: S
authors.lastname: Fukuda
authors.forename: Masao
authors.initials: M
authors.lastname: Hara
authors.forename: Koji
authors.initials: K
authors.lastname: Okuda
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hiraki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Shirouzu
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Aoyagi
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology*; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000473:pathology*; D001706:Biopsy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D003251:Constriction, Pathologic; D003937:Diagnosis, Differential; D005260:Female; D005629:Frozen Sections; D005704:Gallbladder / Q000000981:diagnostic imaging; D006801:Humans; D014463:Ultrasonography