Langwieler T E, Kim J S, Mann O, Thonke F, Knoefel W T, Rogiers X, Izbicki J R
Department of Surgery, University of Hamburg, Martinistrasse 52, D-20246 Hamburg, Germany.
Surg Endosc. 2004 Apr;18(4):717-8. doi: 10.1007/s00464-003-4259-0.
It is frequently difficult to determine whether a bile duct stricture is benign or harbors a malignant tumor based on medical history alone. Therefore, cholestasis of unknown etiology requires a thorough diagnostic evaluation to make a definitive diagnosis and choose the best course of treatment for the patient. We report the case of a 42-year-old man who developed cholestasis 6 years after undergoing orthotopic liver transplantation for end-stage liver disease. The bile duct was dilated by interventional endoscopy, and a brush cytology was obtained. Cytology revealed an inflammatory reaction. Three months later, the stricture persisted. We performed a forceps biopsy, and the diagnosis of a cholangiocarcinoma was confirmed histologically. We conclude that a combined application of brush biopsy/forceps biopsy and endoscopic measures is essential in cases of bile duct strictures of unknown etiology. Occasionally, surgical confirmation may be required. In any case, a single brush cytology is insufficient for diagnosis.
仅根据病史往往很难确定胆管狭窄是良性的还是存在恶性肿瘤。因此，病因不明的胆汁淤积需要进行全面的诊断评估，以做出明确诊断并为患者选择最佳治疗方案。我们报告了一例42岁男性患者的病例，该患者在接受终末期肝病原位肝移植6年后出现胆汁淤积。通过介入性内镜检查使胆管扩张，并获取了刷检细胞学样本。细胞学检查显示有炎症反应。三个月后，狭窄仍然存在。我们进行了钳取活检，组织学检查确诊为胆管癌。我们得出结论，对于病因不明的胆管狭窄病例，联合应用刷检活检/钳取活检及内镜措施至关重要。偶尔可能需要手术确诊。无论如何，单次刷检细胞学检查不足以确诊。
