A case of primary sclerosing cholangitis associated with tumor-forming pancreatitis

Abstract

A 63 year-old man, complaining of abdominal pain and jaundice, visited our hospital. The first examination of ultrasound (US) revealed dilation of bile ducts and a hypoechoic mass in the pancreatic head. Percutaneous transhepatic cholangiography showed smooth stenosis of both intrapancreatic bile duct and bilateral hepatic ducts. From pancreatographic, angiographic and cholangioscopic findings, pancreatic or bile duct cancer was nearly ruled out. The examination of US disclosed that the bile duct wall was thickened to show three-layer structure, so sclerosing cholangitis was strongly suspected. Therefore, cholangioplasty was performed followed by administration of steroid agents. Serial US disclosed that pancreatic tumor decreased in size and then disappeared. The patient had been doing well, but he was admitted 6 months later due to exacerbation of liver function. Ultrasonography, performed on the second admission, revealed that bile duct wall was thickened to 5 mm in width. After re-administration of steroid, the duct wall became thinner to 3mm and jaundice was improved.