Hilar Biliary Obstruction: Malignant Masquerades

ABSTRACT

Biliary obstruction at the hepatic hilus is most often due to malignancy. Clinically, it can be very difficult to differentiate malignant from benign obstruction when a mass lesion is not evident on cross-sectional imaging. In this article, we describe three cases of benign biliary obstruction due to so-called malignant masquerades to familiarize the reader with the clinical, radiographic, and pathological features of these uncommon but important entities.

Biliary obstruction - autoimmune pancreatitis - chemotherapy-induced biliary sclerosis - Clonorchis sinensis

REFERENCES

• 1 Principe A, Ercolani G, Paolucci U et al.. Diagnostic dilemmas in biliary strictures mimicking cholangiocarcinoma.  Hepatogastroenterology. 2003;  50 1246-1249
• 2 Corvera C U, Blumgart L H, Darvishian F et al.. Clinical and pathologic features of proximal biliary strictures masquerading as hilar cholangicarcinoma.  J Am Coll Surg. 2005;  201 862-869
• 3 Weber S M, Cubukcu-Dimopulo O, Palesty J A et al.. Lymphoplasmacytic sclerosing pancreatitis: inflammatory mimic of pancreatic carcinoma.  J Gastrointest Surg. 2003;  7 129-137
• 4 Kim K P, Kim M H, Kim J C, Lee S S, Seo D W, Lee S K. Diagnostic criteria for autoimmune chronic pancreatitis revisited.  World J Gastroenterol. 2006;  12 2487-2496
• 5 Kamisawa T, Egawa N, Nakajima H, Tsuruta K, Okamoto A, Kamata N. Clinical difficulties in the differentiation of autoimmune pancreatitis and pancreatic carcinoma.  Am J Gastroenterol. 2003;  98 2694-2699
• 6 Hamano H, Kawa S, Horiuchi A et al.. High serum IgG4 concentrations in patients with sclerosing pancreatitis.  N Engl J Med. 2001;  344 732-738
• 7 Fukui T, Okazaki K, Yoshizawa H et al.. A case of autoimmune pancreatitis associated with sclerosing cholangitis, retroperitoneal fibrosis and Sjogren's syndrome.  Pancreatology. 2005;  5 86-91
• 8 Cohen A D, Kemeny N E. An update on hepatic arterial infusion chemotherapy for colorectal cancer.  Oncologist. 2003;  8 553-566
• 9 Kemeny N, Huang Y, Cohen A M et al.. Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer.  N Engl J Med. 1999;  341 2039-2048
• 10 Aldrighetti L, Arru M, Ronzoni M et al.. Extrahepatic biliary stenosis after hepatic arterial infusion (HAI) of floxuridine (FUdR) for liver metastases from colorectal cancer.  Hepatogastroenterology. 2001;  48 1302-1307
• 11 Martin R C, Edwards M J, McMasters K M. Morbidity of adjuvant hepatic arterial infusion pump chemotherapy in the management of colorectal cancer metastatic to the liver.  Am J Surg. 2004;  188 714-721
• 12 Brown K T, Kemeny N, Berger M F et al.. Obstructive jaundice in patients receiving hepatic artery infusional chemotherapy: etiology, treatment implications, and complications after transhepatic biliary drainage.  J Vasc Interv Radiol. 1997;  8 229-234
• 13 Ensminger W, Knol J, DeRemer S et al.. Effects of dexamethasone or celecoxib on biliary toxicity after hepatic arterial infusion of 5-fluorodeoxyuridine in a canine model.  Cancer Res. 2004;  64 311-315
• 14 Kemeny N, Seiter K, Niedzqiecki D et al.. A randomized trial of intrahepatic infusion of fluorodeoxyuridine with dexamethasone versus fluorodeoxyuridine alone in the treatment of metastatic colorectal cancer.  Cancer. 1992;  69 327-334
• 15 Shea Jr W J, Demas B E, Goldberg H I et al.. Sclerosing cholangitis associated with hepatic arterial FUDR chemotherapy: radiographic-histologic correlation.  AJR Am J Roentgenol. 1986;  146 717-721
• 16 Hohn D, Melnick J, Stagg R et al.. Biliary sclerosis in patients receiving hepatic arterial infusions of floxuridine.  J Clin Oncol. 1985;  3 98-102
• 17 Liao W C, Wang H P, Chiu H M, Chang C Y, Lin J T. Multiple hepatic nodules: rare manifestation of clonorchiasis.  J Gastroenterol Hepatol. 2006;  21 1497-1500
• 18 Choi B I, Han J K, Hong S T, Lee K H. Clonorchiasis and cholangiocarcinoma: etiologic relationship and imaging diagnosis.  Clin Microbiol Rev. 2004;  17 540-552
• 19 Binkley C E, Eckhauser F E, Colletti L M. Unusual causes of benign biliary strictures with cholangiographic features of cholangiocarcinoma.  J Gastrointest Surg. 2002;  6 676-681