Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma Journal Article
| Authors: | Corvera, C. U.; Blumgart, L. H.; Darvishian, F.; Klimstra, D. S.; DeMatteo, R.; Fong, Y.; D'Angelica, M.; Jarnagin, W. R. |
| Article Title: | Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangiocarcinoma |
| Abstract: | BACKGROUND: Nontraumatic inflammatory hilar strictures are uncommon, but are known to mimic malignancy. This study examines the clinical and pathologic features of benign idiopathic strictures. STUDY DESIGN: Patients without a history of trauma or earlier biliary operation treated for benign strictures were identified. Clinical information was obtained from the medical record and all resected specimens were reexamined. RESULTS: From January 1992 to July 2003, 275 patients with proximal biliary strictures were referred. Among these, 22 patients had a final histologic diagnosis of benign stricture, despite a suspected preoperative diagnosis of malignancy. All 22 patients underwent resection of the extrahepatic biliary tree, which in 10 patients was combined with en bloc partial hepatectomy. Histologic reexamination identified five different benign processes: lymphoplasmacytic sclerosing pancreatitis and cholangitis, primary sclerosing cholangitis, granulomatous disease, nonspecific fibrosis/inflammation, and stone disease. Major postoperative morbidity occurred in 6 (26%) patients but none died. No preoperative clinical or radiographic features were identified that could reliably distinguish patients with benign strictures from those with cancer. CONCLUSIONS: "Malignant masquerade" of the proximal bile duct results from several different underlying conditions, and differentiating benign strictures from cancer remains problematic. The treatment approach should continue to be resection for presumed malignancy. © 2005 by the American College of Surgeons. |
| Keywords: | adolescent; adult; clinical article; human tissue; aged; aged, 80 and over; middle aged; retrospective studies; clinical feature; clinical trial; cancer diagnosis; diagnosis, differential; differential diagnosis; morbidity; pathology; medical record; radiography; bile duct carcinoma; biliary tract surgery; bile duct neoplasms; bile ducts, intrahepatic; cholangiocarcinoma; bile duct obstruction; partial hepatectomy; granulomatosis; bile duct injury; sclerosing cholangitis; primary sclerosing cholangitis; constriction, pathologic; cholestasis, extrahepatic |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 201 |
| Issue: | 6 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2005-12-01 |
| Start Page: | 862 |
| End Page: | 869 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2005.07.011 |
| PUBMED: | 16310689 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 34" - "Export Date: 24 October 2012" - "CODEN: JACSE" - "Source: Scopus" |
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5Corvera -
10
Darvishian -
352Blumgart -
637DeMatteo -
978Klimstra -
916Jarnagin -
775Fong -
791D'Angelica
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