Ketsekioulafis Ioannis, Serpetsidaki Evanthia, Tribonias Georgios, Vezakis Antonios, Myoteri Despoina
Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Aretaieion University Hospital, Athens, GRC.
Department of Pathology, Venizeleio General Hospital, Heraklion, GRC.
Cureus. 2023 Feb 7;15(2):e34738. doi: 10.7759/cureus.34738. eCollection 2023 Feb.
Primary sclerosing cholangitis (PSC) is a rare, chronic, and progressive disease of the liver characterized by cholestasis due to multifocal bile duct strictures. PSC can lead to liver fibrosis, and in 10-20% of cases, it leads to cholangiocarcinoma and end-stage liver disease. However, the pathogenesis of the disease is not clearly understood. For the diagnosis of PSC, both imaging and liver biopsy can be used. No medical treatment has managed to prevent the progression of the disease. Consequently, in the case of late-stage disease, liver transplantation is considered the best treatment option. PSC may lead to different complications including bacterial cholangitis, cholangiocarcinoma, and cirrhosis. Nevertheless, to our knowledge, there are no reports of granulomatous peritonitis secondary to PSC. Granulomatous peritonitis may be a result of infectious, malignant, and idiopathic inflammatory diseases. It is also considered a rare postoperative complication, due to cornstarch from surgical glove powder, in laparoscopic procedures. Here, we report the case of a 39-year-old male patient with PSC, in which cholangiocarcinoma and peritoneal carcinomatosis were clinically suspected. Despite that, histological findings and staining methods of the surgically removed peritoneal masses demonstrated granulomatous peritonitis.
原发性硬化性胆管炎（PSC）是一种罕见的慢性进行性肝脏疾病，其特征是由于多灶性胆管狭窄导致胆汁淤积。PSC可导致肝纤维化，在10%-20%的病例中，可导致胆管癌和终末期肝病。然而，该疾病的发病机制尚不清楚。对于PSC的诊断，可采用影像学检查和肝活检。目前尚无药物治疗能够阻止该疾病的进展。因此，对于晚期疾病，肝移植被认为是最佳治疗选择。PSC可能导致不同的并发症，包括细菌性胆管炎、胆管癌和肝硬化。然而，据我们所知，尚无PSC继发肉芽肿性腹膜炎的报道。肉芽肿性腹膜炎可能是由感染性、恶性和特发性炎症性疾病引起的。它也被认为是一种罕见的术后并发症，在腹腔镜手术中，由手术手套粉末中的玉米淀粉引起。在此，我们报告一例39岁男性PSC患者，临床怀疑患有胆管癌和腹膜癌转移。尽管如此，手术切除的腹膜肿块的组织学检查结果和染色方法显示为肉芽肿性腹膜炎。
