Review for 10.1186/s12876-020-01519-1 (2020)

Reviewer’s report
Title: 
Granulomatous cholangitis mimicking hilar cholangiocarcinoma: A case
report
Version: 
0 
Date: 
01 Oct 2020
Reviewer's report:
- a case report on a rare condition should, among all, guide clinical reasoning of
the physician to reach a correct diagnosis, by excluding step-by step all the other
disorders, starting from the most common ones. Hence, I would have described
in more details patient's anamnesis (i.e. family history of hepatobiliary disorders;
medications; recent travel history; history of alcohol/drugs consumption;
exposure to thorotrast; possible exposure to liver flukes such as Opisthorchis
viverini and Clonorchis sinensis). 
- among the laboratory exams, you have correctly assessed for the positivity of
ANA in the suspect of AIH. Being ANA 1:320 a diagnostic parameter for AIH,
have you checked for the presence of second level antibodies (ASMA, SLA/LP,
LKM, LC1)? Have you assessed total IgG? If so, I would mention it, since we
are talking of a relatively young and healthy woman with new and rapid onset of
liver markers alteration. Furthermore, since AIH was excluded, are there possible
reasons for ANA positivity? 
-I would add some relevant information about the clinical course of the disease.
In particular, has the patient remained apyretic for the whole time? Have her
blood analysis and vital signs remained similar to the ones of referral?
-Since blood exams at the time of referral showed evidence of increased
inflammatory markers, even if the patient was not febrile, were blood and urine
cultures assessed? Furthermore, have you assessed stools samples (in particular
looking for parasitic infections)?
-The phrase used in the discussion "it is desirable to avoid excessive invasion if
there is a possibility of benign disease" in my opinion should be better explained.
How can you be sure of the malignancy of the disease before surgery?
-Since the initial diagnostic suspect was the one of cholangiocarcinoma, an
highly aggressive and metastatic tumor, have you assessed for the presence of
distant metastasis by performing a total body (not only abdomen) CT scan; MR
or PET before surgical intervention? if so, I would mention it.  
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