IgG4-related sclerosing cholangitis mimicking cholangiocarcinoma

Author:

Ng Wei R1,Lau Ngee-Soon2,Fadia Mitali3,Gananadha Sivakumar1

Affiliation:

1. North Canberra Hospital Department of General Surgery, , Bruce, ACT 2617 , Australia

2. Canberra Hospital Hepatopancreatobiliary Unit, , Garran, ACT 2605 , Australia

3. Canberra Hospital Department of Anatomical Pathology, , Garran, ACT 2605 , Australia

Abstract

Abstract A man in his 70s presented to the emergency department with painless obstructive jaundice. Initial blood test results show a predominantly cholestatic picture with elevated tumour markers, and imaging findings are concerning for a pancreatic head neoplasm or cholangiocarcinoma with involvement of the entire common bile duct. The patient underwent staging laparoscopy and biopsies including peritoneal washing, but did not identify any features of malignancy. Immunoglobulin G and immunoglobulin G4 testing were subsequently tested and shown to be elevated. The provisional diagnosis of immunoglobulin G4-related sclerosing cholangitis was made, and steroid treatment was empirically started. Treatment with steroids was successful, with complete resolution of symptoms and abnormal imaging findings and near complete resolution of liver function test results after 1 month.

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference12 articles.

1. Autoimmune cholangitis and cholangiocarcinoma;Li;J Gastroenterol Hepatol,2012

2. IgG4-related sclerosing disease;Kamisawa;World J Gastroenterol,2008

3. IgG4-related sclerosing cholangitis

4. Diagnosis and treatment of IgG4-related disease

5. Immunoglobulin G4–associated cholangitis: clinical profile and response to therapy;Ghazale;Gastroenterology,2008

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