Piccino Marco, Hoxhaj Ilda, Grossi Ugo, Romano Maurizio, Brizzolari Marco, Scopelliti Michele, Finotti Michele, Zanus Giacomo
2nd Surgery Unit, "Ca' Foncello" Regional Hospital, 31100 Treviso, Italy.
Surgical-Oncological-Gastroenterological Science Department (DISCOG), University of Padua, 35122 Padova, Italy.
J Clin Med. 2023 Aug 3;12(15):5104. doi: 10.3390/jcm12155104.
Hilar bile duct strictures are mostly caused by malignant lesions. The morphological appearance of perihilar cholangiocarcinomas in various imaging modalities have other malignant and even benign mimics, which pose challenges to an accurate diagnosis and treatment and drive to futile surgery. Herein, we present the case of a 50-year-old woman admitted with jaundice and abdominal pain, elevated bilirubin level, liver function tests and carbohydrate antigen 19-9 level. Magnetic resonance cholangio-pancreatography (MR-CP) and the computed tomography with contrast enhancement revealed a suspected extrahepatic cholangiocarcinoma of the common bile duct. Further spontaneous resolution of the scenario, confirmed by diagnostic assessment, changed the clinical hypothesis in favor of a non-oncological disease. Indeed, the multidisciplinary evaluation supported a diagnosis of transient cholangitis secondary to non-evident intrahepatic lithiasis rather than cholangiocarcinoma. After a 26-month follow-up, the patient was asymptomatic with normal tumor markers and laboratory data. Consecutive MR-CPs showed no suspicion of malignancy. This case report underlines the need for an accurate preoperative assessment in patients with suspected cholangiocarcinoma.
肝门部胆管狭窄大多由恶性病变引起。各种影像学检查中肝门周围胆管癌的形态表现还有其他恶性甚至良性的类似病变，这对准确诊断和治疗构成挑战，并导致手术徒劳无功。在此，我们报告一例50岁女性患者，因黄疸、腹痛、胆红素水平升高、肝功能检查及糖类抗原19-9水平升高入院。磁共振胆胰管造影（MR-CP）和增强计算机断层扫描显示胆总管疑似肝外胆管癌。经诊断评估证实，病情进一步自发缓解，改变了临床诊断思路，倾向于非肿瘤性疾病。实际上，多学科评估支持诊断为继发于隐匿性肝内结石的短暂性胆管炎，而非胆管癌。经过26个月的随访，患者无症状，肿瘤标志物和实验室数据正常。连续的MR-CP检查未发现恶性病变迹象。本病例报告强调了对疑似胆管癌患者进行准确术前评估的必要性。
