title: Advanced adenosquamous carcinoma of the gallbladder with bilio-biliary fistula: an uncommon case treated by hepatopancreatoduodenectomy.
abstract: A 70 year-old female, who presented with jaundice and abdominal pain, was found to have an advanced gallbladder cancer involving the liver parenchyma, duodenum, and transverse colon. This was complicated by a bilio-biliary fistula between the gallbladder and both the right and left hepatic ducts. After obtaining an accurate pre-operative diagnosis, the patient underwent hepatopancreatoduodenectomy (HPD) with lymph node dissection around the hepatic pedicle, celiac trunk, aorta, and inferior vena cava. Histologic examination revealed adenosquamous carcinoma. This rare variant accounts for 3.5% of gallbladder cancers, and is associated with a worse prognosis than adenocarcinoma. The patient is in good condition without any signs of recurrence 42 months after the HPD. In this case report, we discuss the histological type and internal biliary fistula with regard to the literature, and the usefulness of an aggressive surgical procedure such as HPD with extended lymph node dissection which can improve survival and quality of life in selected patients.
authors.affiliation: First Department of Surgery, Nagoya University School of Medicine, Japan.
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.forename: M
authors.initials: M
authors.lastname: Nagino
authors.forename: T
authors.initials: T
authors.lastname: Sano
authors.forename: J
authors.initials: J
authors.lastname: Kamiya
authors.forename: S
authors.initials: S
authors.lastname: Kondo
authors.forename: M
authors.initials: M
authors.lastname: Kanai
authors.forename: H
authors.initials: H
authors.lastname: Nishio
authors.forename: Y
authors.initials: Y
authors.lastname: Nimura
mesh_terms: D000368:Aged; D001649:Bile Duct Diseases / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D001658:Biliary Fistula / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D018196:Carcinoma, Adenosquamous / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002758:Cholangiography; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006500:Hepatic Duct, Common / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D016577:Pancreaticoduodenectomy; D011788:Quality of Life; D014057:Tomography, X-Ray Computed