Benign Biliary Stricture Mimicking Bile Duct Carcinoma

Lee, Eun Jung; Park, Sang Jae; Suh, Kyung Suk; Han, Joon Koo; Yoon, Yong Bum; Park, Yong Hyun; Kim, Sun Whe

Abstract

BACKGROUND/AIMS: There are some cases difficult to discriminate between benign biliary stricture and malignant one even through intraoperative findings and frozen biopsy. We reviewed our experiences of cancer-mimic benign biliary stricture to find whether there are any clinicopathological characteristics helpful for differentiation.
PATIENTS AND METHODS
From 1991 to 1998, we have had 9 patients with cancer-mimic benign biliary stricture without definite causes such as stones, operation and etc. Their clinicopathological findings were reviewed.
RESULTS
Only 5 patients had jaundice. Serum tumor markers were normal in all patients. Cholangiographic findings of 6 cases were compatible with bile duct cancer presenting long segment stricture and abrupt cut-off of bile duct. Six patients had CT findings compatible to cancer such as enhanced mass, thickened bile duct wall, or enlarged lymph node. Stricture site was hilar duct in 5 cases(2 cases : Bismuth type II ; 1 case : IIIa ; 2 cases : IV) and intrahepatic bile duct in 4 cases. Laparotomy was performed in 8 cases(4 cases : resection of strictured bile duct ; 2 cases : left lobectomy ; 1 case : right lobectomy ; 1 case : left lateral segmentectomy). In one case, choledochoscopic biopsy and balloon dilatation were performed. According to the operative findings, 2 cases underwent radical cancer operations. Pathological findings were chronic inflammatory cholangitis which have inflammatory cell infiltration in mucosal and submucosal layer, submucosal fibrosis, hypertrophy and stenosis of bile duct wall, which could be observed also in the secondary stricture caused by stone or infection.
CONCLUSION
Primary benign biliary stricture should be included in the differential diagnosis for bile duct obstruction. Tumor marker and choledochoscopy as well as radiologic study might be helpful to differentiate it from the malignant stricture. Some of these cases might be categorized into rare type of primary sclerosing cholangitis.