Biliary tuberculosis mimicking cholangiocarcinoma: treatment with metallic biliary endoprothesis

Abstract

A 58-yr-old patient who presented with obstructive jaundice was evaluated with ultrasonography (US), computed tomography (CT), and percutaneous transhepatic cholangiography (PTC). Diffuse irregular stenosis of the extrahepatic bile ducts and periductal ill-defined soft tissue density along the hepatoduodenal ligament was determined. The patient was originally misdiagnosed with cholangiocarcinoma and, because the extent of disease process made surgical bypass impossible, was treated with a percutaneously inserted metallic stent. Histopathological examination of the endoluminal biopsy revealed ductal tuberculosis (TB). Most of the previous reports in the literature indicated that biliary obstruction was due to enlarged tuberculous lymph nodes compressing the bile duct. To our knowledge, only three cases of biliary stricture due to tuberculous involvement of the bile ducts were reported previously. This case illustrates the importance of tissue diagnosis in all cases of obstructive jaundice to avoid missing rare but curable diseases.

Hepatobiliary Tuberculosis: Imaging Findings

“…These strictures generally appear in a multisegmental fashion with subsequent segmental parenchymal atrophy of the involved liver segments [63]. Involvement of the extrahepatic biliary system is rare [64].…”

Klatskin-Like Lesions

“…Hilar strictures in biliary TB are difficult to distinguish from cholangiocarcinoma, but the younger age (<40 years in two-thirds), history of low-grade fever before the onset of jaundice, presence of extra hepatic TB and calcifications in the liver are suggestive [72]. Brush cytology demonstrating acid-fast bacilli (AFB), biopsies showing caseating granulomas, and bile PCR for AFB are useful tests [71, 73, 74]. Hilar nodal disease and compression from granulomas may also cause ductal abnormalities on imaging.…”

Biliary Tract Tuberculosis—a Diagnostic Dilemma

“…20,21 PCR testing of the bile aspirate or ERCP brushings for M. tuberculosis is extremely sensitive and should probably be used more commonly. 22,23 In most of the cases reported, the biliary stricture did not resolve with medical therapy alone and usually required biliary metallic stent placement or surgical intervention. 20,22 A fibrotic reaction during antituberculosis therapy leading to worsening of jaundice has been reported in 6-25% of patients.…”

“…22,23 In most of the cases reported, the biliary stricture did not resolve with medical therapy alone and usually required biliary metallic stent placement or surgical intervention. 20,22 A fibrotic reaction during antituberculosis therapy leading to worsening of jaundice has been reported in 6-25% of patients. 24,25 Summary Biliary TB closely mimics malignancy.…”