Korean J Pancreas Biliary Tract.  2015 Jan;20(1):51-56. 10.15279/kpba.2015.20.1.51.

A Case of Malignant Biliary Stricture Mimicking Benign Stricture coincided with Clonorchis sinensis

• Kim H
• Han JH
• Park SM
• Kim JT
• Jang JS
• Lee HS
• Lee S
• Yeon M

• KMID: 2448474
• DOI: http://doi.org/10.15279/kpba.2015.20.1.51

Abstract

Accurate and early diagnosis of indeterminate bile duct stricture is difficult. There are numerous cases suggesting similarity between benign tumors and malignancy. Therefore, meticulous evaluation with endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound and computed tomography (CT) is necessary. A 50 year-old male presented with painless jaundice. Abdominal CT scan showed distal biliary stricture without definite pancreatic mass. Repeated brush cytology and endobiliary biopsy during ERCP did not reveal malignancy except for eggs of Clonorchis sinensis. The patient declined surgical resection without definite evidence of malignancy. Abdominal CT scan one month later showed progressive parenchymal atrophy and pancreatic duct dilatation. The patient underwent pylorus preserving pancreatoduodenectomy. Pathology revealed pancreatic adenocarcinoma in the head portion. Since accurate preoperative diagnosis of malignant biliary obstruction can be evasive, patients with biliary stricture should undergo evaluation with high index of suspicion.

Keyword

Clonorchis sinensis; Bile duct stricture; Pancreas cancer

MeSH Terms

Adenocarcinoma
Atrophy
Bile Ducts
Biopsy
Cholangiopancreatography, Endoscopic Retrograde
Clonorchis sinensis*
Constriction, Pathologic*
Diagnosis
Dilatation
Early Diagnosis
Eggs
Head
Humans
Jaundice
Male
Ovum
Pancreatic Ducts
Pancreatic Neoplasms
Pancreaticoduodenectomy
Pathology
Pylorus
Tomography, X-Ray Computed
Ultrasonography