title: A rare surgical case of metachronous double carcinoma of the biliary tract.
abstract: We report on a rare case of metachronous double carcinoma of the biliary tract, occurring in a 65-year-old male. The patient was admitted to the hospital with jaundice in March 2004. Ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) scans of the abdomen showed a minimally dilated intrahepatic biliary tree with normal-appearing choledocus. Obstruction of the common hepatic duct was revealed by endoscopic retrograde cholangiopancreatography (ERCP). The patient underwent a resection of the middle third of the extrahepatic duct and cholecystectomy (cholangiocarcinoma, pT1N0M0), with the surgical margins of resection showing as negative. After 2 years, during follow-up, the findings of a positron emission tomography (PET)-CT scan suggested a possible cholangiocarcinoma of the distal part of the biliary tract; CT and MRI scanning of the abdomen showed mild dilatation of the distal common hepatic duct; an ERCP showed mild dilatation of the retropancreatic remnant of the biliary tree with endoluminal defects. Eventually the patient underwent pancreaticoduodenectomy. The histopathological diagnosis of the resected specimen confirmed a cholangiocarcinoma; 10 lymph nodes were negative (pT1N0M0). At 6 months post-op after the second operation the patient is progressing well with no signs of recurrence. Patients with cholangiocarcinoma - in whom survival is prolonged with surgical resection - should undergo careful follow-up for both recurrence and second primary cancer. PET scanning seems to play the most important diagnostic role.
authors.affiliation: Department of Medical and Surgical Sciences, Clinica Chirurgica III, University of Padova School of Medicine, Padova, Italy. roberto.merenda@unipd.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Merenda
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Portale
authors.forename: Giacomo Carlo
authors.initials: GC
authors.lastname: Sturniolo
authors.forename: Fioretta
authors.initials: F
authors.lastname: Marciani
authors.forename: Alvise Maffei
authors.initials: AM
authors.lastname: Faccioli
authors.forename: Ermanno
authors.initials: E
authors.lastname: Ancona
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome