Nontraumatic inflammatory hilar strictures are uncommon, but are known to mimic malignancy.
Dr William Jarnagin and colleagues from New York examines the clinical and pathologic features of benign idiopathic strictures.
The investigative team identified patients without a history of trauma or earlier biliary operation treated for benign strictures.
Clinical information was obtained from the medical record and all resected specimens were reexamined.
From 1992 to 2003, the team referred 275 patients with proximal biliary strictures.
| Histologic reexamination identified 5 different benign processes|
|Journal of the American College of Surgeons|
The investigators reported that 22 had a final histologic diagnosis of benign stricture, despite a suspected preoperative diagnosis of malignancy.
All 22 patients underwent resection of the extrahepatic biliary tree, which in 10 patients was combined with en bloc partial hepatectomy.
Histologic reexamination identified 5 different benign processes.
The investigators found that lymphoplasmacytic sclerosing pancreatitis and cholangitis were benign.
Primary sclerosing cholangitis, granulomatous disease, nonspecific fibrosis/inflammation, and stone disease were also benign.
The investigators noted that major postoperative morbidity occurred in 6 patients but none died.
The team identified no preoperative clinical or radiographic features that could reliably distinguish patients with benign strictures from those with cancer.
Dr Jarnagin's team concluded, “A ‘Malignant masquerade' of the proximal bile duct results from several different underlying conditions, and differentiating benign strictures from cancer remains problematic.”
“The treatment approach should continue to be resection for presumed malignancy.”