A case of intrahepatic peripheral secondary screrosing cholangitis diagnosed as liver malignant tumor

Abstract

A 71-year-old man underwent pancreaticoduodenectomy (II region) for a pancreatic neuroendocrine tumor (PNET). He was periodically followed-up at an outpatient clinic. Six years after surgery, contrast-enhanced abdominal CT revealed a tumorous lesion, measuring 20 mm, with an unclear border and enhancement effects on the S4 liver surface. MRI with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA-enhanced MRI) also showed a low-signal-intensity area at the same site in the hepatocellular phase. Under a tentative diagnosis of primary liver cancer or metastatic liver tumor from PNET, partial hepatectomy (S4) was conducted. In the resected specimen, a white, irregular mass with a clear border was observed. Histopathological findings included marked fibrous thickening of the bile duct wall and the infiltration of inflammatory cells, leading to a diagnosis of sclerosing cholangitis. His medical history suggested secondary sclerosing cholangitis after biliary-tract reconstruction. To the best of our knowledge, there have been no case reports published on secondary sclerosing cholangitis localized in the peripheral intrahepatic bile duct. Although a preoperative diagnosis is difficult, resection should be considered if the possibility of malignant tumors cannot be ruled out.