Early bile duct cancer in a background of sclerosing cholangitis and autoimmune pancreatitis.
A 59-year-old man presented with recent onset jaundice. Initial laboratory and radiologic findings suggested autoimmune pancreatitis (AIP) with consequent obstructive jaundice. All serologic markers for AIP were, however, normal. To confirm the histologic finding of AIP and exclude the possibility of cancer at the thickened segment of common bile duct, cholangioscopic examination was performed and bile duct cancer was observed. The resected specimen showed typical features of AIP throughout the entire pancreas and early carcinomatous change on a background of abundant IgG4-positive cells in the common bile duct. Although chronic biliary inflammation and cholestasis are among bile duct cancer risk factors, the cause-and-effect relationship between sclerosing cholangitis and bile duct cancer needs to be determined by further study, as between AIP and pancreatic cancer. Importantly, histologic exclusion of malignancy is another essential step in the diagnosis of AIP and sclerosing cholangitis as malignancy may coexist in bile duct as well as in the pancreas.
Oh
Hyoung-Chul
HC
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Kim
Jae Gyu
JG
Kim
Jeong Wook
JW
Lee
Kwang Sun
KS
Kim
Mi Kyung
MK
Chi
Kyong Choun
KC
Kim
Yong Seok
YS
Kim
Ki Hyun
KH
D001327:Autoimmune Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D001650:Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D055088:Early Detection of Cancer; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy