Korean J Gastroenterol.  2022 Jul;80(1):38-42. 10.4166/kjg.2022.066.

Portal Biliopathy Misdiagnosed as Hilar Cholangiocarcinoma

• Kim SY
• Moon SH
• Cho YA
• Lee SM
• Kim JH

• KMID: 2532166
• DOI: http://doi.org/10.4166/kjg.2022.066

Abstract

Portal biliopathy refers to the changes in the bile duct caused by portal vein thrombosis or obstruction. It is assumed to be caused by cavernous transformation due to the development of the venous system surrounding the bile duct, but the exact pathology is still unknown. Biliary morphologic abnormalities of portal biliopathy are discovered incidentally on radiographic images, but it is sometimes difficult to differentiate them from cholangiocarcinoma. Given the poor prognosis of cholangiocarcinoma, a surgical approach can be considered when the diagnosis is uncertain. Herein, we report a case of portal biliopathy with bile ductal wall thickening, which was diagnosed after surgical resection was performed due to the presumed diagnosis of cholangiocarcinoma.

Keyword

Bile ducts; Cholangiocarcinoma; Portal vein

Figure

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  Fig. 1 Computed tomography scan shows (A, B) extensive left portal vein thrombosis (arrows) with bile duct dilatation (arrowhead of B). (C) Microvasculatures were noted around the bile duct on the arterial phase (dotted circle). (D) Coronal reformatted image shows hilar bile duct wall thickening with stenosis (arrow).

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  Fig. 2 Magnetic resonance imaging. (A) On the T2-weighted image, the venous collaterals are shown as dark signal voids (dotted circle). (B) On the contrast-enhanced image, the bile duct wall thickening with collaterals is shown as a linear enhancing lesion (oval dotted circle). (C) Magnetic resonance cholangiopancreatography shows hilar bile duct stricture (arrow) with proximal duct dilatation.

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  Fig. 3 18F-flourodeoxyglucose positron emission tomography/computed tomography shows (A, B) mild FDG uptake lesions (dotted circle of A) in the hepatic hilar and left intrahepatic duct area (maximum standard unit value=3.17), suggesting a malignant tumor.

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  Fig. 4 (A) Increasing fibroblasts with mixed inflammatory cells. There is no increase in lymphoplasma cells (hematoxylin and eosin stain [H&E], ×40). (B, C) Some thinning of the ectatic vessel is observed. (B) H&E, ×2.5 (scan view). (C) H&E, ×2.5.

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