A case of challenging diagnosis of cholangiocarcinoma

Abstract

A 79 year old man was admitted in our hospital and examined for pre-operative evaluation of right lower lung mass of pulmonary in October 2008.
We examined for diagnosis of the stricture. Peroral cholangioscopy (POCS) was initially perfomed to show irregular elevated lesion in lower common bile duct close to major papilla, where taking biopsy speciemen and brushing cytology were performed.
We performed third ERCP and lower common bile duct showed severe stricture. The biopsy of the stricture lesion and the major papilla finally revealed classIIIb and classV (adenocarcinoma) respectively.
We have experienced a difficult case of cholangiocarcinoma which initially seemed to be unknown cause of inflammatory stricture with no malignancy evidence of biopsies specimen. We have recognized that it is important to continually follow up to investigate unidentified cause of bile duct stricture to rule out malignancy with repeated biopsy and POCS.