ABSTRACT
Solid liver and pancreatic masses are commonly neoplastic in nature; however, inflammatory
lesions mimicking carcinoma are at times encountered in these sites. We report two
cases of previously undescribed inflammatory mass lesions of the liver and pancreas
that originated in the biliary tract. Detailed clinical and histologic evaluations
were performed in two patients who underwent right partial hepatic lobectomy and Whipple's
resection for presumed hepatic and pancreatic neoplasms. In case 1, with a remote
history of cholecystectomy and recent extraction of a stone from the common bile duct,
a liver mass in segment 6 was discovered incidentally. In case 2, a periampullary
pancreatic mass was diagnosed radiographically following papillotomy and stent insertion
for stricture and biliary calculous disease. The histologic findings in both cases
were similar, localized around a part of the biliary tract, and consisted of inspissated
bile, acute and chronic inflammation, abundant lipid-laden macrophages, fibrosis,
and giant cell reaction. No neoplasm was identified. On the basis of the close resemblance
of these features to those seen in xanthogranulomatous cholecystitis, the lesions
seen here were termed xanthogranulomatous choledochitis. In conclusion, xanthogranulomatous
choledochitis is a benign inflammatory process involving the biliary tract that can
form a mass lesion within the liver or pancreas and thus mimic a neoplasm. Extensive
sampling of the lesion is required to rule out an underlying neoplastic process. In
our patients a propensity to form lithogenic bile and a prior history of biliary tract
operative procedure were present.
KEYWORDS
Xanthogranulomatous inflammation - bile duct - choledochitis - hepatobiliary neoplasm
- benign
