Mid common bile duct inflammatory pseudotumor mimicking cholangiocarcinoma. A case report and literature review

Abstract

INTRODUCTIONBiliary inflammatory pseudotumors (IPTs) represent an exceptional benign cause of obstructive jaundice. These lesions are often mistaken for cholangiocarcinomas and are treated with major resections, because their final diagnosis can be achieved only after formal pathological examination of the resected specimen. Consequently, biliary IPTs are usually managed with unnecessary major resections.PRESENTATION OF CASEA 71-year-old female patient underwent an extra-hepatic bile duct resection en-bloc with the gallbladder and regional lymph nodes for an obstructing intraluminal growing tumor of the mid common bile duct (CBD). Limited resection was decided intraoperatively because of negative for malignancy fast frozen sections analysis in addition to the benign macroscopic features of the lesion. Histologically the tumor proved an IPT, arising from the bile duct epithelium, composed of inflammatory cells and reactive mesenchymal tissues.DISCUSSIONThe present case underlines the value of intraoperative reassessment of patients undergoing surgical resection for histopathologically undiagnosed biliary occupying lesions, in order to optimize their surgical management.CONCLUSIONThe probability of benign lesions mimicking cholangiocarcinoma should always be considered to avoid unnecessary major surgical resections, especially in fragile and/or elderly patients.

Resección endoscópica bajo visión coledocoscópica de pólipo biliar. Reporte de un caso

“…A menudo, se confunden con colangiocarcinomas y son tratados con resecciones mayores. 1,2 La etiología de los STI sigue sin resolverse. Entre las diversas hipótesis fisiopatológicas propuestas, la más probable es el antecedente de infecciones bacterianas, parasitarias o virales, principalmente el virus de Epstein-Barr.…”

“…Los signos radiológicos de la colangiopancreatografía por resonancia magnética (CRMN) y de la colangiopancreatografía retrógrada endoscópica (CPRE) más sugestivos para el diagnóstico de un pólipo biliar serían la presencia de defectos de repleción, fijos unilateralmente a la pared del árbol biliar, sin menisco y sin estenosis circunferencial del conducto afectado. 1…”

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

“…Surgical resection or bypass operations are indicated for the management of biliary IPTs ensur ing a satisfactory prognosis, provided that the tumour has been proved clearly benign. The probability of IPTs in patients undergo ing surgical exploration should always be considered and the extent of the resection should be determined by the intraoperative findings and fast frozen section analysis [135].…”

Inflammatory myofibroblastic tumor of common bile duct

“…В работе M. Patnana и соавт., такие опухоли даже получили образное название «великого подражателя» («great mimicker») [22]. Клинические проявления и характеристики воспалительных псевдоопухолей в виде механической желтухи и холангита, наличия внутрипротоковых тканевых масс и инфильтрации стенок желчного протока очень схожи с таковыми при холангиокарциноме [11,20]. В связи с этим правильный окончательный диагноз нередко удается поставить только после операции.…”