Hong Kong Med J 2010;16:149-52 | Number 2, April 2010
Immunoglobulin G4–associated sclerosing cholangitis mimicking cholangiocarcinoma
Daniel TM Chung, CN Tang, Eric CH Lai, George PC Yang, Michael KW Li
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
Immunoglobulin G4–related lymphoplasmacytic sclerosing disease is an emerging disease. Recently, it has been shown to be responsible for autoimmune pancreatitis-induced strictures of the bile duct mimicking cholangiocarcinoma. Making a diagnosis of immunoglobulin G4–associated sclerosing cholangitis requires a high index of suspicion. The differential diagnoses include primary sclerosing cholangitis, cholangiocarcinoma, and pancreatic cancer. The preoperative diagnosis is likely to be missed due to the lack of specific symptoms; a clinical presentation that may mimic other disorders, especially malignant biliary strictures; and the lack of specific imaging features. This article reports on a 51-year-old man with immunoglobulin G4–associated sclerosing cholangitis without autoimmune pancreatitis. He underwent resection of his extrahepatic bile duct with a hepaticojejunostomy. The diagnosis was confirmed after a histopathological examination. This case highlights the obstacles to making a preoperative diagnosis of immunoglobulin G4–associated sclerosing cholangitis.
Key words: Autoimmune diseases; Cholangiocarcinoma; Cholangitis, sclerosing; Immunoglobulin G; Pancreatitis
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