title: Curative resection of a huge bile duct cancer without pancreatoduodenectomy.
abstract: A 71-year-old woman was admitted to our hospital with obstructive jaundice. Magnetic resonance cholangiography revealed a 9-cm spindle-shaped tumor in the common bile duct. Laboratory examination noted a high concentration of total serum bilirubin. Although the serum concentration of carcinoembryonic antigen was within normal limits, the serum concentration of carbohydrate antigen 19-9 was elevated. We diagnosed the lesion as an extrahepatic bile duct cancer and performed a laparotomy. The anterior wall of the common bile duct was incised, and the tumor was found to have a small base in only the posterior wall of the duct, and spread within the duct was from the common hepatic duct to the intrapancreatic bile duct. Bile duct resection, cholecystectomy with lymphadenectomy and hepaticojejunostomy were performed. Frozen sections of the proximal and distal surgical margins of the bile duct were free of cancer. Macroscopically, the lesion was an expansive polypoid tumor measuring 9x3cm in diameter arising from a 5-mm base. Histologic examination revealed that the tumor was a well-differentiated tubular adenocarcinoma that had infiltrated the fibromuscular layer at its base. Longitudinal spread was more extensive hepatopetally than hepatofugally. The patient is alive and well without any complaints 8 months after surgery.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. m8827074@msic.med.osaka-cu.ac.jp
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hirohashi
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Uenishi
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Taichi
authors.initials: T
authors.lastname: Shuto
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Masao
authors.initials: M
authors.lastname: Ogawa
authors.forename: Keiichi
authors.initials: K
authors.lastname: Yamasaki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D002758:Cholangiography; D003138:Common Bile Duct Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006500:Hepatic Duct, Common / Q000473:pathology / Q000601:surgery*; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D007582:Jejunostomy / Q000379:methods*; D008279:Magnetic Resonance Imaging; D009361:Neoplasm Invasiveness; D016577:Pancreaticoduodenectomy