A Resected Case of Follicular Cholangitis That Was Positive on 18F-fluorodeoxyglucose-positron Emission Tomography

Abstract

We experienced a case of follicular cholangitis that was positive on fluorodeoxyglucose-positron emission tomography (¹⁸F-FDG-PET). A 70-year-old man was admitted for jaundice. Endoscopic retrograde cholangiography showed stenosis of the middle to upper choledocus. ¹⁸F-FDG-PET depicted a localized hot spot at the stenotic lesion (maximum standardized uptake value = 8.2). Although no malignant findings were found in the cytology or on a bile duct biopsy, malignancy could not be excluded, so surgical treatment was performed. Follicular cholangitis is a new, rare disease that causes severe biliary stricture. Only 11 cases of follicular cholangitis have been reported, including the present case.

Keywords: 18F-FDG-PET; biliary stricture; cholangiocarcinoma; follicular cholangitis.

Figure 1.

a: Computed tomography demonstrated the stenosis of the upper part of the choledocus. b: Endoscopic retrograde cholangiography showed the stenotic lesion at the upper part of the choledocus.

Figure 2.

¹⁸F-FDG-PET demonstrated a localized hot spot (SUV_max=8.2) at the upper choledocus without any other organ accumulation.

Figure 3.

a: Macroscopic appearance of the resected specimen showed upper bile duct fibrotic stenosis without an obvious solid tumor. b: A microscopic examination revealed follicular cholangitis accompanied by a germinal center (Hematoxylin and Eosin staining).

Figure 4.

Immunostaining of the stenotic lesion of the choledocus. a: IgG1 staining as control, b: IgG4 staining, very few IgG4-positive cells were observed. c: CD10 staining showed lymphoid cells, d: MIB-1staining was positive, e: Maspin staining and p53 staining (f) were negative.