Canadian Association of Pathologists - Case of the Month - January 2008
Two GI Surgical Pathology Cases
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Diagnosis Page - Case 2
Microscopic Description:
Sections of the white scarred area show calculi in large intrahepatic bile ducts eroding epithelium and associated with acute and chronic cholangitis. There is large bile duct ectasia with extensive fibrocollagenous scarring, periductal onion-skinning fibrosis and many foci of subacute inflammation. The hepatic microstructure at the margins of inflammatory scarring process appears normal. No parasites are noted. There is no evidence of dysplasia.
Diagnosis:
Hepatolithiasis with recurrent pyogenic cholangitis
Comment:
Recurrent pyogenic cholangitis occurs in association with intrahepatic pigment stones and intrahepatic biliary tract obstruction. Pyogenic bile duct infection occurs predominantly due to seeding of the biliary system by coliform bacteria and initiates the cascade of stone formation and recurrent cholangitis. Predisposing factors include parasites and malnutrition, both increasing the susceptibility of bile ducts to bacterial seeding. Long-term complications include cirrhosis with portal hypertension and cholangiocarcinoma. Recurrent pyogenic cholangitis is prevalent in East Asia and Hong Kong. In North America it is seen mainly in immigrant populations.
References:
- Al-Sukhi W. et al. Recurrent pyogenic cholangitis with the hepatolithiasis- The role of surgical therapy in North America. J Gastrointestinal Surg. 2007 Nov 13.