Middle bile duct cancer with portal vein tumor thrombus.
BACKGROUND
Tumor thrombus in the portal vein is a common complication of hepatocellular carcinoma, but an extremely rare complication of common bile duct cancer.


METHODS
A 78-year-old woman was referred to our department because of jaundice. Laboratory data showed severe liver dysfunction with high serum levels of total bilirubin and CA19-9. Computed tomography showed lesions in the middle bile duct and main portal vein. FDG PET scan and 3D imaging showed hot spots in the same location as those revealed by CT. Under a diagnosis of middle bile duct cancer with portal vein tumor thrombus, the patient underwent surgery. At laparotomy, the main tumor was found to be located in the middle bile duct with a tumor thrombus, 2 cm in diameter, in the main portal vein. The patient underwent pancreatoduodenectomy with thrombectomy. Histological examination showed that this thrombus had the same histological features as those of the main bile duct cancer (poorly differentiated adenocarcinoma). The postoperative course was uneventful and the patient is doing well without any signs of recurrence 18 months after surgery.


CONCLUSIONS
To our knowledge, this is the first report of successful resection of middle bile duct cancer with portal vein tumor thrombus.
Shimoda
Mitsugi
M
Department of Gastroenterological Surgery, Dokkyo University School of Medicine, Tochigi, Japan. shimodamitsugi@hotmail.com
Iso
Yukihiro
Y
Tomita
Shigeki
S
Fujimori
Takahiro
T
Murakami
Koji
K
Sawada
Tokihiko
T
Kubota
Keiichi
K
D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000175:diagnosis; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D009360:Neoplastic Cells, Circulating; D011169:Portal Vein; D049268:Positron-Emission Tomography; D020246:Venous Thrombosis / Q000209:etiology*
D019788:Fluorodeoxyglucose F18