title: Bile duct carcinoma arising in metaplastic biliary epithelium of the intestinal type: a case report.
abstract: We report herein a case of distal bile duct carcinoma showing intestinal differentiation diagnosed 3 years after endoscopic sphincterotomy for choledocholithiasis. The diagnostic problem in this case was that the granular mucosa, which is a typical finding of superficial mucosal extension of bile duct carcinoma in general, was interpreted as hyperplasia accompanying metaplasia in cholangioscopic biopsy. Discrimination of superficial mucosal cancer extension from hyperplastic mucosa with metaplastic changes was impossible using cholangioscopic examination. In our case, reflux and stasis of the duodenal and pancreatic juice into the biliary tract might have occurred because of abnormal function of the papilla of Vater following endoscopic sphincterotomy. It might be suggested that endoscopic sphincterotomy contributed to the metaplastic changes in the bile duct mucosa in our case.
authors.affiliation: First Department of Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sano
authors.forename: Junichi
authors.initials: J
authors.lastname: Kamiya
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Uesaka
authors.forename: Koji
authors.initials: K
authors.lastname: Oda
authors.forename: Michio
authors.initials: M
authors.lastname: Kanai
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D001706:Biopsy; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002780:Cholestasis, Intrahepatic / Q000473:pathology*; D003135:Common Bile Duct / Q000473:pathology; D003138:Common Bile Duct Neoplasms / Q000473:pathology*; D004724:Endoscopy; D004848:Epithelium / Q000473:pathology; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000473:pathology; D009361:Neoplasm Invasiveness; D011183:Postoperative Complications / Q000473:pathology*; D011230:Precancerous Conditions / Q000473:pathology*; D016717:Sphincterotomy, Endoscopic