Department of Surgery, University of Auckland, New Zealand.
HPB (Oxford). 2001;3(3):235-9. doi: 10.1080/136518201753242280.
A variety of causes of inflammatory bile duct stricture can masquerade as hilar cholangiocarcinoma. Eosinophilic cholangitis is a further example.
A 50-year-old woman with epigastric pain and deranged liver function was found to have a stricture of the common hepatic duct on ERCP with an associated mass on MRl.The lesion was excised with reconstruction of the right and left hepatic ducts, and the patient recovered well. Histopathological examination of the resected gallbladder and bile duct showed diffuse inflammation with a predominant eosinophil infiltrate.The presence of Candida albicans in the bile duct lumen can probably be attributed to the preoperative biliary stent.There was a modest postoperative rise in peripheral eosinophil count.
A literature search reveals only six previous cases of eosinophilic cholangitis, but similar infiltrates have also been seen in occasional cholecystectomy specimens. As the present patient did not have gallstones, the aetiology remains unclear. Peripheral eosinophilia is an unreliable clue to the diagnosis, which is usually likely to escape detection until the biliary stricture has been resected.
多种原因可引起炎症性胆管狭窄，这些原因可能类似于肝门部胆管癌。嗜酸细胞性胆管炎则是另一个例子。
一位 50 岁女性因上腹痛和肝功能异常，在 ERCP 检查中发现肝总管狭窄，同时 MRI 检查发现胆管内有一个肿块。通过切除病变并重建左右肝管，患者恢复良好。切除的胆囊和胆管的组织病理学检查显示弥漫性炎症，伴嗜酸性粒细胞浸润为主。胆管腔内白色念珠菌的存在可能归因于术前胆道支架。术后外周血嗜酸性粒细胞计数略有升高。
文献检索仅发现 6 例嗜酸细胞性胆管炎的先前病例，但在偶尔的胆囊切除术标本中也观察到类似的浸润。由于本患者没有胆囊结石，病因仍不清楚。外周血嗜酸性粒细胞增多不是诊断的可靠线索，通常在胆道狭窄切除之前可能不会被发现。
