Difficulty of preoperative diagnosis of Immunoglobulin G4-related sclerosing cholangitis: Report of a case

Abstract

A 76-year-old male with a complaint of obstructive jaundice was admitted to our hospital. CT and MRI demonstrated hilar mass and dilated intrahepatic bile duct. PET/CT image showed abnormal FDG uptake in the same lesion. ERCP demonstrated the hilar biliary stenosis and IDUS showed a hilar mass with invasion into surrounding tissue. Brushing cytology revealed class V. We diagnosed this case as a hilar cholangiocarcinoma preoperatively and underwent right hepatectomy and resection of extrahepatic bile duct. After histopathological examination, marked infiltration of IgG4-positive plasma cells and fibrosis were observed around the bile duct. Finally, this case was diagnosed as an Immunoglobulin G4-related sclerosing cholangitis.