Follicular cholangitis: beyond tumour mimicry

Follicular cholangitis is a rare entity that may closely mimic cholangiocarcinoma, leading to high-impact therapeutic decisions. We report the case of a 50-year-old woman with asymptomatic cholestatic liver enzyme abnormalities whose imaging studies were initially interpreted as infiltrating intrahepatic cholangiocarcinoma. However, histopathological examination of the surgical specimen established the diagnosis of follicular cholangitis. Persistence of cholestatic liver enzyme abnormalities after surgery prompted the initiation of immunosuppressive therapy, resulting in a favourable clinical and biochemical response. This case highlights the diagnostic challenges posed by follicular cholangitis and suggests that the inflammatory process may extend beyond the macroscopically identifiable lesion.