title: Signet ring cell carcinoma of the extrahepatic bile duct diagnosed by preoperative biopsy: a case report.
abstract: A 73-year-old woman was admitted because of obstructive jaundice. Computed tomography revealed a stricture in the lower bile duct with enhanced bile duct wall. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a tapering stenosis at the lower bile duct. Transpapillary histological biopsy using biopsy forceps through ERCP was performed; the diagnosis of signet ring cell carcinoma (SRCC) of the bile duct was established. Regional lymph node enlargement and distant metastases were not detected on diagnostic imaging. Pancreaticoduodenectomy with pylorus preservation was performed. Histological examination of the resected specimen confirmed SRCC of the extrahepatic bile duct coexisting with adenocarcinoma (ADC) of the extrahepatic bile duct with negative resection margins. However, tumor cells directly invaded the pancreatic parenchyma and the muscle layer of the duodenum, prompting us to administer adjuvant chemotherapy to the patient, with no sign of tumor recurrence at 1-year follow-up. Almost all tumors originating from the extrahepatic bile duct are ADC and other histological variants are rare. Of these, SRCC is extremely rare and only four cases have been reported. Furthermore, to the best of our knowledge, this is the first case report regarding the preoperative diagnosis of SRCC of the bile duct. Current reports indicate that younger age and Asian ethnicity are the clinical features of SRCC of the extrahepatic bile duct. Immunohistochemical staining of CK7, CK20 and MUC2 may be useful for predicting prognosis. Chemotherapy has not resulted in increased survival rates and only surgical resection currently serves as a curative treatment.
authors.affiliation: Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan.
authors.forename: Emiri
authors.initials: E
authors.lastname: Kita
authors.affiliation: Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Tsujimoto
authors.affiliation: Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sudo
authors.affiliation: Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Hara
authors.affiliation: Department of Surgery, Chiba Cancer Center, Chiba, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Kainuma
authors.affiliation: Department of Surgery, Chiba Cancer Center, Chiba, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Clinical Pathology, Chiba Cancer Center, Chiba, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Itami
authors.affiliation: Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yamaguchi
keywords: Bile duct carcinoma; Jaundice; Signet ring cell carcinoma