Abstract
Intrahepatic bile duct stricture is a relatively rare clinicopathological entity. In the diagnosis of the stricture, we often have difficulties in determining whether it is benign or malignant before surgery. The case presented in this paper involved a 73-year-old man with a previous history of pancreatic head cancer. The patient showed an abnormally high serum CA19-9 level, 3,321 U/ml. Abdominal MRI revealed a localized dilatation at the lateral segment B2 of the left lobe of liver and a faint high signal intensity area at the dorsal aspect of the root B2 on T2-weighted images. FDG-PET showed an abnormal uptake of FDG to an area where was identical with the tumor. A possibility of intrahepatic bile duct cancer could not be ruled out, and lateral segmentectomy of the left hepatic lobe was performed. No malignant findings were demonstrated in the removed specimen. Both the stricture and the dilated portion at the bile duct wall showed remarkable fibrosis, with areas accompanied by extensive lymphocytes and plasma cell infiltration. Immunohistochemical stain revealed significantly abundant IgG4-positive plasma cells. Consequently intrahepatic bile duct stricture due to IgG4-related sclerosing cholangitis was diagnosed. The serum CA19-9 level was normalized 4 months after the operation. The patient has been recurrence free as of 4 years after the operation.
This paper also presents bibliographic comments on the treatment of intrahepatic bile duct stricture and IgG4-related sclerosing cholangitis.
