Inflammatory Fibroid Polyp of the Intrahepatic Biliary Tract: First Documented Case and Diagnostic Relevance of SpyGlass DS Cholangioscopy.

A 19-year-old female presented with recurrent upper abdominal pain, pruritus, and jaundice. Imaging and endoscopic evaluation revealed a high-grade biliary stricture in the hilum and left hepatic bile duct with a tumor-like lesion. Repeated brush and fluoroscopic guided biopsies failed to yield a definitive diagnosis. Using SpyGlass DS single-operator cholangioscopy, targeted biopsies were obtained, indicating a benign mesenchymal neoplasm. Due to persistent cholestasis and suspected malignancy, left hemihepatectomy was performed. Final histopathology revealed an inflammatory fibroid polyp of the intrahepatic bile duct - a previously undocumented localization. The patient recovered fully after surgery. This case highlights that inflammatory fibroid polyps can present as biliary tumors and underscores the diagnostic value of SpyGlass DS cholangioscopy in evaluating indeterminate biliary strictures.