Benign inflammatory pseudotumour mimicking extrahepatic bile duct cholangiocarcinoma in an adult man presenting with painless obstructive jaundice

Abstract

Inflammatory pseudotumours (IPTs) of the biliary tract are extremely rare and heterogeneous by aetiology and clinical presentation. They might cause biliary obstruction and mimic cholangiocarcinomas and their final diagnosis is usually achieved only after surgical excision. The most characteristic feature of IPT is the presence of chronic inflammatory cell infiltrates with variable degree of proliferating fibrous tissue. IPTs have the potential for recurrence even after resection and if untreated they can grow causing a variety of symptoms due to compression of the surrounding structures and organs. Despite the significant improvement of modern imaging techniques, preoperative distinction between IPTs of the biliary system and malignancies is extremely difficult. Histological diagnosis poses a clinical challenge because sampling is often suboptimal. Although rare, IPTs should be in the differential diagnosis of patients who present with painless jaundice and no other clinical symptoms or signs characteristics of cholangiocarcinomas.

Benign Tumours and Pseudotumours Within the Porta Hepatis Masquerading as Perihilar Cholangiocarcinoma

“…These imag ing findings are remarkably similar to those of HC [132]. In addition, preoperative tumour sampl ing is technically challenging and it usually results in suboptimal dia gnosis [133]. Notwithstand ing this, distinction between IPTs and malignant lesions is crucial, because IPTs have a benign bio logical behaviour and are characterised by the property of spontaneous regression [134].…”

Jaundice may be the only clinical manifestation of primary hepatosplenic diffuse large B-cell lymphoma: a case report and literature review

“…Painless jaundice is a common clinical manifestation of many diseases, such as viral hepatitis, ischemic hepatitis, alcohol- or drug-induced hepatitis, primary biliary cirrhosis, hemochromatosis, malignancies, Wilson’s disease, and autoimmune hepatitis. 11 – 15 The differential diagnosis of painless jaundice is broad and complicate. Laboratory workups including a complete blood cell count; serum AST, ALT, ALP, total and direct bilirubin, and γ-glutamyl transpeptidase measurements; and urinalysis should be performed in the initial evaluation of painless jaundice, which can help clarify whether it is an obstructive process.…”

Torsion of omental fibrous pseudotumour mimicking acute appendicitis

“…It is postulated that these tumours may represent a late stage of inflammatory myofibroblastic tumour [ 2 ]. Fibrous pseudotumours have been reported to affect, among other sites, the tongue [ 3 ], scrotum [ 4 ], adrenal gland [ 5 ], extrahepatic bile ducts [ 6 ], stomach [ 7 , 8 ], gallbladder [ 9 ] and omentum [ 10 ]. To our knowledge, this is the first report of omental fibrous pseudotumours presenting as an acute abdomen due to acute torsion and infarction.…”