Mucosal bile duct carcinoma with superficial spread.
We describe a case of mucosal bile duct carcinoma with superficial spread in a 69-year-old man with gallstone pancreatitis. The patient was seen at the hospital because of abdominal pain, fever, and jaundice. Endoscopic retrograde cholangiography (ERC) demonstrated a protruding lesion in the lower third of the common bile duct (CBD) showing wall irregularity suggestive of malignancy. Percutaneous transhepatic cholangioscopy (PTCS) disclosed a papillary tumor with granular mucosa extending continuously to the middle third of the CBD. Cholangioscopic biopsy specimens taken from both the papillary tumor and surrounding granular mucosa revealed papillary adenocarcinoma. After this assessment of extent of cancer by PTCS, we performed pancreatoduodenectomy with extrahepatic bile duct resection and regional lymph node dissection. Pathology examination revealed papillary adenocarcinoma limited to the mucosal layer. The resected margin of the bile duct was free of tumor. We also reviewed 25 cases of early mucosal bile duct carcinoma described in detail in the Japanese literature, and we discuss the diagnostic advantages of PTCS.
Iwahashi
N
N
Department of Surgery, Tohkai Hospital, 1-1-1 Chiyodabashi, Chikusa-ku, Nagoya, 464-0011 Japan.
Hayakawa
N
N
Yamamoto
H
H
Maki
A
A
Kawabata
Y
Y
Murayama
A
A
Nimura
Y
Y
Kamiya
J
J
Nagino
M
M
Mori
N
N
D000231:Adenocarcinoma, Papillary / Q000473:pathology*; D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003135:Common Bile Duct; D006801:Humans; D008297:Male; D009092:Mucous Membrane; D009361:Neoplasm Invasiveness