Perihilar lymph nodes in patients with primary sclerosing cholangitis with and without cholangiocellular carcinoma.
OBJECTIVE
Enlarged perihilar lymph nodes have been described in patients with primary sclerosing cholangitis (PSC). The aim of the study was to determine the clinical relevance of perihilar lymph nodes in PSC patients with and without cholangiocellular carcinoma (CCC).


METHODS
The status of perihilar lymph nodes was investigated in 117 patients with PSC using "high-end" ultrasound. Thirty-five of the 117 PSC patients had histologically proven CCC. Lymph node status was correlated with the presence of CCC and inflammatory bowel disease (IBD).


RESULTS
Seventy-three percent of PSC patients without CCC and 86% of patients with CCC had enlarged perihilar lymph nodes (NS). In CCC patients, the width of lymph nodes was significantly larger (12+/-6 mm versus 8+/-4 mm; p=0.0001), and the length:width ratio (2.15+/-0.7:1 versus 2.5+/-0.6:1; p=0.004) of the lymph nodes was significantly lower. Thirty-seven percent of PSC patients without CCC and 57% of patients with PSC and CCC had multiple perihilar lymph nodes (p=0.04). In all patients, the presence versus absence of IBD had no influence on the number (84% versus 74%,) and size of perihilar lymph nodes (length: 21+/-10 mm versus 19+/-7 mm). Lymph node status did not correlate with the number of episodes of cholangitis.


CONCLUSIONS
Enlarged perihilar lymph nodes are characteristic of patients with PSC. Since perihilar lymph nodes are not predictive of the presence of complicating CCC, such patients should not be excluded from liver transplantation.
Kirchner
Gabriele I
GI
Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Germany. Gabriele.Kirchner@Klinik.uni-regensburg.de
Tischendorf
Jens J W
JJ
Bleck
Jörg
J
Wagner
Siegfried
S
Caselitz
Martin
M
Klempnauer
Juergen
J
Manns
Michael P
MP
Gebel
Michael
M
D000328:Adult; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging; D018281:Cholangiocarcinoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D015209:Cholangitis, Sclerosing / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography