Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures

Erdogan, Deha; Kloek, Jaap J.; Kate, F. J. W. ten; Rauws, Erik A.; Busch, Olivier R.; Gouma, Dirk J.; Gulik, Thomas M. van

doi:10.1002/bjs.6057

Cited by 96 publications

(85 citation statements)

References 35 publications

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“…Recently, IgG4-related lymphoplasmacytic sclerosing disease was observed in patients with strictures of the pancreatic duct mimicking carcinoma [20] . In a study from our center, it was shown that IgG4-related sclerosing disease also occurs in patients with benign proximal bile duct strictures [21] . In the present series, two of the ten patients with benign proximal bile duct strictures showed infiltration by IgG4-plasma cells with histological features suggestive of an autoimmune disorder.…”

Section: Discussionmentioning

confidence: 95%

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Kloek¹,

Delden²,

Erdogan³

et al. 2008

WJG

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AIM:To identify the criteria for the differentiation of hilar cholangiocarcinoma (HCCA) from benign strictures. METHODS: A total of 68 patients underwent resection of lesions suspicious for HCCA between 1998 and 2006. The results of laboratory investigations, imaging studies and brush cytology were collected. These findings were analyzed to obtain the final diagnosis. RESULTS: Histological examination of the resected specimens confirmed HCCA in 58 patients (85%, group Ⅰ) whereas 10 patients (15%, group Ⅱ) were diagnosed to have benign strictures. The most common presenting symptom was obstructive jaundice in 77% patients (79% group Ⅰ vs 60% group Ⅱ, P = 0.23). Laboratory findings showed greater elevation of transaminase levels in group Ⅰ compared to group Ⅱ. The various imaging modalities showed vascular involvement exclusively in the malignant group (36%, P < 0.05). Brush cytology was positive for malignant cells in only 50% patients in group Ⅰ whereas none in group Ⅱ showed malignant cells. CONCLUSION: Despite improvements in imaging techniques, 10 patients (15%) with a presumptive diagnosis of HCCA were ultimately found to have benign strictures. Except for vascular involvement which was associated significantly with malignancy, there were no conclusive features of malignancy on regular imaging modalities. This uncertainty should be taken into account when patients with a suspicious lesion at the liver hilum are considered for resection.

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Section: Discussionmentioning

confidence: 95%

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Kloek¹,

Delden²,

Erdogan³

et al. 2008

WJG

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“…Therefore, establishing a definitive diagnosis was challenging in this case. In IgG4-RD patients, malignant tumors are often suspected, and obtaining the differential diagnosis is often very difficult (9). Most patients with IgG4-related cholecystitis exhibit diffuse, circumferential thickening of the gallbladder wall associated with IgG4-SC or AIP.…”

Section: Discussionmentioning

confidence: 99%

Localized IgG4-related Cholecystitis Mimicking Gallbladder Cancer

et al. 2015

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We encountered a case of localized IgG4-cholecystitis mimicking gallbladder cancer with focal/segmental type1 autoimmune pancreatitis (AIP). In this case, we were unable to exclude a diagnosis of gallbladder cancer and thus performed radical cholecystectomy. Type1 AIP is often associated with gallbladder lesions, accompanied by generally diffuse, circumferential thickening of the gallbladder wall. Although localized IgG4-related cholecystitis is extremely rare, differentiating this condition from gallbladder cancer is often very difficult.

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“…4 Before surgery, it was difficult to deny the possibility of cancer because the imaging of IgG4-SC was similar to cancer. PSC was suspected in cases in which bile duct stenosis occurred.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Steroid Administration for Diagnosis of IgG4-Related Sclerosing Cholangitis

Kubo

Suzuki

Kobayashi

et al. 2012

International Surgery

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Immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) is one of the IgG4-related systemic sclerosing diseases and responds well to steroid therapy. A 58-year-old male was admitted with hilar bile duct stenosis revealed by computed tomography. We performed percutaneous transhepatic right portal vein embolization (PTPE) and scheduled a right hepatectomy because a hilar cholangiocarcinoma was first suspected. However, there was no cytologic evidence of malignancy and serum IgG4 was elevated. Steroid therapy was initiated after PTPE. There was no evidence of bile duct stenosis after 4 weeks. Improving diagnostic technique, IgG4-SC was diagnosed and treated with steroid therapy. In some cases, we couldn't deny the malignancy and performed unnecessary resection. We recommend that steroid administration while waiting for the liver volume to increase after PTPE is useful. The therapy aids in the diagnosis of bile duct stenosis, which has value for a hilar bile duct limit type of IgG4-SC, as in the case reported here.

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Immunoglobulin G4-related sclerosing cholangitis in patients resected for presumed malignant bile duct strictures

Cited by 96 publications

References 35 publications

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Differentiation of malignant and benign proximal bile duct strictures: The diagnostic dilemma

Localized IgG4-related Cholecystitis Mimicking Gallbladder Cancer

Usefulness of Steroid Administration for Diagnosis of IgG4-Related Sclerosing Cholangitis

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