Primary sclerosing cholangitis in which differential diagnosis from gallbladder carcinoma was difficult

Abstract

We report a case of localized primary sclerosing cholangitis (PSC) which was difficult to distinguish from gallbladder carcinoma. A 75-year-old woman with elevated serum bilirubin was hospitalized and underwent endoscopic nasobiliary drainage (ENBD). There was no history of diseases such as gallbladder stone, pancreatitis, or ulcerative colitis. Cholangiography through the ENBD tube showed localized stenosis of the common bile duct; the gallbladder could not be seen. Angiography showed no encasement of the hepatic artery. Ultrasonography showed a tumor in the cystic duct, and the tumor had invaded the gallbladder and common bile duct. We diagnosed gallbladder carcinoma on radioimaging, and performed an S4aS5 subsegmentectomy of the liver and resection of the extrahepatic biliary tree. Pathologically, no malignant cells were detected, and fibrosis around bile ducts and infiltration of inflammatory cells into hepatic tissue were found. It is well known that PSC is sometimes difficult to differentially diagnose from cholangiocarcinoma. Our case is of high interest because ultrasonography showed findings suggestive of gallbladder carcinoma. It is therefore necessary to keep the possibility of PSC in mind for the diagnosis and treatment of such localized biliary stenosis.

Mucin-producing carcinoma of the gallbladder associated with primary sclerosing cholangitis and ulcerative colitis

“…In addition, it has also been reported that the prevalence of gallbladder polyps in PSC patients was 4%, and gallbladder neoplasms in PSC are malignant in approximately 40–60% of the cases [4, 5]. Thus, previous reports suggest some correlation among the PSC and UC patients and not only for cholangiocarcinoma but also carcinoma of the gallbladder []. In this report, we demonstrate the clinicopathological features of a mucin‐producing carcinoma of the gallbladder associated with PSC and UC.…”

“…Previous reports suggest some correlation among the PSC and UC patients and not only for cholangiocarcinoma but also carcinoma of the gallbladder [4][5][6][7]. Buckles et al Fig.…”

“…Previous reports suggest some correlation among the PSC and UC patients and not only for cholangiocarcinoma but also carcinoma of the gallbladder []. Buckles et al [5] suggested that the chronically inflamed gallbladder mucosa in PSC patients, like the inflamed colon in ulcerative colitis patients, may be associated with risk of malignant degeneration.…”

Xanthogranulomatous cholecystitis complicated with primary sclerosing cholangitis: Report of a case

“…7 Since the risk of hepatobiliary carcinoma is high in patients with PSC and the differential diagnosis is diffi cult, a cholecystectomy is recommended when a GB mass lesion is detected. 5,8,9 Xanthogranulomatous cholecystitis is a type of chronic cholecystitis characterized by the infi ltration of numerous foamy histiocytes with infl ammatory cells. Bacterial infections, such as Escherichia coli and LPS, and resultant infl ammatory and immunological events are thought to be involved in the pathogenesis of XGC.…”

Primary sclerosing cholangitis treated by endoscopic biliary dilation: Review and long-term follow-up evaluation

“…This patient died of metastases 6 months after transplant. The incidence of gallbladder carcinoma is increased in PSC patients, and it is often difficult to diagnose early in its development [33]. Another type of malignancy occurred 8 years after initial endoscopic therapy in one of our patients presumably from acquisition of Epstein-Barr virus at the time of transplant [34,35].…”