Distal cholangiocarcinoma associated with papillitis with viral CMV inclusions.
Cytomegalovirus (CMV) infections are usually described in immunodeficient patients. In immunocompetent patients active infection is uncommon, consisting usually of a mononucleosis-like syndrome. Numerous reports show that CMV is a potential pathogen in the gastrointestinal tract, even in immunocompetent patients, where it can produce lesions from the mouth to the anus. We report herein an uncommon association of chronic inflammation of the papilla and viral CMV inclusions with distal cholangiocarcinoma in a 72-year-old woman who presented jaundice, choluria, acholia and generalized pruritus. At laparotomy, dilatation of the bile ducts and an enlarged head of the pancreas were found. Pancreatoduodenectomy was performed. Pathology revealed an enlarged papilla, due to chronic inflammation with CMV inclusions. Histological analysis revealed moderately differentiated ductal adenocarcinoma of the distal bile tract.
Department of Surgery, University Hospital Ramón y Cajal, Madrid, Spain. jrtovar@wanadoo.es
Jaime
J
Ruiz-Tovar
Elena
E
Martín-Pérez
Carlos
C
Gamallo-Amat
D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000150:complications*; D003586:Cytomegalovirus Infections / Q000150:complications*; D005260:Female; D006801:Humans; D007181:Inclusion Bodies, Viral; D010183:Pancreatic Ducts