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Case Reports
. 2016 Oct 12;3(4):e141.
doi: 10.14309/crj.2016.114. eCollection 2016 Aug.

The Klatskin Tumor That Wasn't: An Unusual Presentation of Sarcoidosis

Priya D Farooq  1 , Darryn R Potosky  1
Affiliations
Case Reports

The Klatskin Tumor That Wasn't: An Unusual Presentation of Sarcoidosis

Priya D Farooq et al. ACG Case Rep J. .

Abstract

We present the case of a patient who presented with signs and symptoms associated with a Klatskin tumor. After endoscopic retrograde cholangiopancreatography (ERCP) and biopsy, she was found instead to have granulomatous infiltration of the extrahepatic biliary tree consistent with biliary sarcoidosis. The patient was treated successfully with systemic corticosteroids and azathioprine. She later developed cutaneous, lymphatic, and pulmonary granulomatous disease. Isolated biliary disease is a rare initial presentation of systemic sarcoidosis.

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Figures

Figure 1
Figure 1
CT image demonstrating an ill-defined, infiltrative mass at the confluence of the right and left hepatic ducts (arrows).
Figure 2
Figure 2
MRCP showing prominent intrahepatic biliary ductal dilatation proximal to the location of the previously noted hilar mass.
Figure 3
Figure 3
Initial ERCP demonstrating a 10-mm stenosis of the common hepatic duct extending into the takeoff of the right and left hepatic ducts.
Figure 4
Figure 4
Biopsy showing extensive granulomatous (large arrows) inflammation in the wall of the bile duct (small arrows). Scale bar, 1 μm.
Figure 5
Figure 5
A third MRCP after 6 months of medical therapy showing resolution of the intrahepatic ductal dilatation.
See this image and copyright information in PMC

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