Document Detail

Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma.
MedLine Citation:
PMID:  16310689     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Nontraumatic inflammatory hilar strictures are uncommon, but are known to mimic malignancy. This study examines the clinical and pathologic features of benign idiopathic strictures. STUDY DESIGN: Patients without a history of trauma or earlier biliary operation treated for benign strictures were identified. Clinical information was obtained from the medical record and all resected specimens were reexamined. RESULTS: From January 1992 to July 2003, 275 patients with proximal biliary strictures were referred. Among these, 22 patients had a final histologic diagnosis of benign stricture, despite a suspected preoperative diagnosis of malignancy. All 22 patients underwent resection of the extrahepatic biliary tree, which in 10 patients was combined with en bloc partial hepatectomy. Histologic reexamination identified five different benign processes: lymphoplasmacytic sclerosing pancreatitis and cholangitis, primary sclerosing cholangitis, granulomatous disease, nonspecific fibrosis/inflammation, and stone disease. Major postoperative morbidity occurred in 6 (26%) patients but none died. No preoperative clinical or radiographic features were identified that could reliably distinguish patients with benign strictures from those with cancer. CONCLUSIONS: "Malignant masquerade" of the proximal bile duct results from several different underlying conditions, and differentiating benign strictures from cancer remains problematic. The treatment approach should continue to be resection for presumed malignancy.
Carlos U Corvera; Leslie H Blumgart; Farbod Darvishian; David S Klimstra; Ronald DeMatteo; Yuman Fong; Michael D'Angelica; William R Jarnagin
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Publication Detail:
Type:  Journal Article     Date:  2005-10-13
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  201     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-11-28     Completed Date:  2006-01-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  862-9     Citation Subset:  AIM; IM    
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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MeSH Terms
Aged, 80 and over
Bile Duct Neoplasms / diagnosis*,  pathology
Bile Ducts, Intrahepatic / pathology*
Cholangiocarcinoma / diagnosis*,  pathology
Cholestasis, Extrahepatic / etiology*,  pathology,  surgery
Constriction, Pathologic
Diagnosis, Differential
Middle Aged
Retrospective Studies

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