Proximal bile duct stricture disguised as malignant neoplasm

Background. Discrimination of malignant proximal bile duct (PBD) stricture from a benign lesion is difficult with nonsurgical methods; indeed, 8% to 1 3% of PBD strictures prove to be benign after histologic examination of the surgically resected specimen. Methods. In a 7-year period 178 patients with PBD stricture were admitted, and 99 of them underwent radical resection for presumably malignant lesions . In 14 of these patients the stenotic lesions were proved to be benign by postoperative histologic assessment. We reviewed these patients retrospecti vely by collecting data from their charts. Results. Preoperative radiologic findings including cholangiography and ang iography wee compatible with malignancy in all 14 patients. Preoperative hi stologic studies suggested malignancy in 2 of 8 examined. Findings at lapar otomy could not allow differentiation between malignant and benign lesions in any of the patients and strongly suggested malignancy in 3. Histologic e xamination of the resected specimens revealed extensive fibrosis with infla mmatory cellular infiltration in all patients. There was 1 episode of signi ficant morbidity postoperatively (transient cholangitis) but no mortality. Conclusion. Benign PBD strictures, although rare, are usually indistinguish able from malignant PBD strictures by preoperative or perioperative investi gation. Given the minimal morbidity, all PBD strictures should be presumed malignant and managed accordingly, even at the risk of overtreating some be nign cases.