Eosinophilic cholangitis: a case of 'malignant masquerade'
M S Rodgers1, J P Allen, J B Koea
1Department of Surgery, University of Auckland, New Zealand.
Summary
Eosinophilic cholangitis is a rare cause of bile duct stricture that can mimic cancer. Diagnosis often requires surgical resection, as peripheral eosinophilia is an unreliable indicator.
Area of Science:
- Gastroenterology
- Hepatology
- Pathology
Background:
- Inflammatory bile duct strictures can mimic hilar cholangiocarcinoma.
- Eosinophilic cholangitis is a rare differential diagnosis presenting with biliary obstruction.
Purpose of the Study:
- To report a case of eosinophilic cholangitis presenting as a common hepatic duct stricture.
- To review the literature on eosinophilic cholangitis and its diagnostic challenges.
Main Methods:
- Case presentation of a 50-year-old woman with epigastric pain and abnormal liver function.
- Endoscopic retrograde cholangiopancreatography (ERCP) and Magnetic Resonance Imaging (MRI) revealed a stricture and mass.
- Surgical excision and histopathological examination of the resected specimen.
Main Results:
- Histopathology showed diffuse inflammation with a predominant eosinophil infiltrate in the bile duct.
- The patient recovered well after surgical resection and reconstruction.
- Literature review identified only six previous cases of eosinophilic cholangitis.
Conclusions:
- Eosinophilic cholangitis can present as biliary stricture, often requiring resection for diagnosis.
- Peripheral eosinophilia is not a reliable diagnostic marker.
- The etiology of eosinophilic cholangitis remains unclear in cases without gallstones.
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