Proximal bile duct stricture disguised as malignant neoplasm

Area of Science:

• Hepatobiliary Surgery
• Gastroenterology
• Surgical Pathology

Background:

• Proximal bile duct (PBD) strictures pose diagnostic challenges, with a notable percentage misidentified as malignant.
• Nonsurgical methods often fail to reliably distinguish between malignant and benign PBD strictures.

Purpose of the Study:

• To evaluate the diagnostic accuracy of preoperative and perioperative methods in differentiating benign from malignant proximal bile duct strictures.
• To assess the clinical implications of misdiagnosing benign PBD strictures as malignant.

Main Methods:

• Retrospective chart review of 178 patients with PBD stricture over 7 years.
• Analysis of 14 patients whose presumed malignant PBD strictures were histologically confirmed as benign post-resection.
• Review of preoperative radiologic (cholangiography, angiography) and histologic findings, as well as intraoperative assessments.

Main Results:

• All 14 benign PBD strictures were radiologically indistinguishable from malignant ones.
• Preoperative histology and intraoperative findings also failed to differentiate benign from malignant lesions.
• Postoperative histology revealed extensive fibrosis and inflammation in all benign cases.
• Surgical resection resulted in minimal morbidity (1 transient cholangitis) and no mortality.

Conclusions:

• Benign proximal bile duct strictures are difficult to distinguish from malignant ones using current preoperative and perioperative investigations.
• Due to diagnostic limitations and low surgical morbidity, a presumptive malignant approach is recommended for all PBD strictures to avoid undertreatment.