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論文種別	症例報告
言語種別	英語
査読の有無	査読なし
表題	Difficulty Achieving a Preoperative Diagnosis of IgG4-Related Sclerosing Cholangitis
掲載誌名	正式名：Case reports in gastroenterology 略　 称：Case Rep Gastroenterol ISSNコード：1662-0631(Print)1662-0631(Linking)
掲載区分	国外
巻・号・頁	12(2),pp.425-31
著者・共著者	Suzumura Kazuhiro, Hatano Etsuro, Tada Masaharu, Sueoka Hideaki, Nishida Hiroshi, Iida Kenjiro, Hai Seikan, Miyamoto Hayato, Andoh Tatsuya, Ueki Takahiro, Nonaka Kentaro, Nakasho Keiji, Fujimoto Jiro
発行年月	2018/08
概要	A 75-year-old male was admitted to our hospital because of bile duct stenosis. He had no medical history of autoimmune disease. The level of tumor markers, serum IgG, and IgG4 were within normal ranges. Computed tomography showed perihilar and distal bile duct stenosis and wall thickening without swelling or abnormal enhancement of the pancreas. Endoscopic retrograde cholangiopancreatography showed perihilar and distal bile duct stenosis. A biopsy and cytology from the distal bile duct stenosis suggested adenocarcinoma, and cytology from the perihilar bile duct also suggested adenocarcinoma. A preoperative diagnosis of perihilar and distal bile duct cancer was made, and the patient underwent left hepatectomy and pancreaticoduodenectomy. Resected specimens showed wall thickening in the perihilar and distal bile duct; however, tumors were unclear. A histopathological examination revealed lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis in the perihilar and distal bile ducts. Immunohistochemistry revealed diffuse infiltration of IgG4-positive plasma cells in the perihilar and distal bile ducts. Lymphoplasmacytic infiltration, inflammatory change, storiform fibrosis, and obliterative phlebitis were shown in the pancreas. A final diagnosis of IgG4-related sclerosing cholangitis (IgG4-SC) with autoimmune pancreatitis was made. We herein report a case in which a preoperative diagnosis of IgG4-SC was difficult due to normal serum IgG4 levels and no obvious pancreatic lesion.
DOI	10.1159/000490523
PMID	30186095