title: Papillary in situ and intramucosal adenocarcinoma of the lower third of common bile duct. A report and review of the literature.
abstract: We report the case of a 37-year-old woman with no relevant medical history. She was admitted to the hospital for epigastric pain related with food intake for 4 days; the pain did not improve with symptomatic management. A laparoscopic cholecystectomy due to acute lithiasic cholecystitis was performed. However, after 4 days, postoperative painless jaundice was evident; thus, endoscopic retrograde cholangiopancreatography was performed, which revealed an amputation of intrapancreatic common bile duct, as well as secondary intra- and extrahepatic bile duct dilatation. Brushing of the distal portion of the common bile duct revealed a well-differentiated adenocarcinoma. Therefore, a Whipple procedure with pylorus preservation was performed. Pathologic diagnosis of a papillary in situ adenocarcinoma with two microscopic foci of microinvasion was established. The pathologic Tumor-Node-Metastasis (TNM) stage was pT1, pN0, pM0, R0. The patient is asymptomatic and disease-free 24 months after surgery. In general, adenocarcinomas of the extrahepatic bile ducts are uncommon and have a poor prognosis. However, symptomatic patients with early disease stages are even rarer and can be cured surgically.
authors: Departamento de Gastroenterología, Fundación Clínica Médica Sur, Mexico City, Mexico; Servicio de Cirugía General, Unidad 304, Hospital General de México. Mexico City, Mexico; Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
authors: Eduardo E
authors: EE
authors: Montalvo-Javé
authors: Departamento de Patología, Fundación Clínica Médica Sur, Mexico City, Mexico.
authors: Fredy
authors: F
authors: Chablé-Montero
authors: Departamento de Gastroenterología, Fundación Clínica Médica Sur, Mexico City, Mexico.
authors: Liz N
authors: LN
authors: Toapanta-Yanchapaxi
authors: Departamento de Gastroenterología, Fundación Clínica Médica Sur, Mexico City, Mexico.
authors: Fernando
authors: F
authors: Rojas-Mendoza
authors: Facultad Mexicana de Medicina, Universidad la Salle (ULSA), Mexico City, Mexico.
authors: Carlos
authors: C
authors: López-Caballero
authors: Departamento de Anestesiología y Terapia Respiratoria. Fundación y Clínica Médica Sur, Mexico City, Mexico.
authors: Mario L
authors: ML
authors: Roca-Cabrera
authors: Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
authors: Germán E
authors: GE
authors: Mendoza-Barrera
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000601:surgery; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003135:Common Bile Duct; D005260:Female; D006801:Humans