A Case Report of Multicentric Papillary Cholangiocarcinoma

Toshiomi Kusano, Masato Furukawa, Toshinori Nakata, Yiqin Lin, Kazunori Tashiro, Seiichiro Watabe, Kaoru Itose, Hidetoshi Jyono, Toshifumi Eto*, Tsukasa Tsunoda*, Ryoichi Tsuchiya*

Department of Surgery, Nagasaki Chuo National Hospital
*The Second Department of Surgery, Nagasaki University School of Medicine

We report a case of multicentric pappilary cholangiocarcinoma resected mainly from the standpoint of how to detect tumor-free margin of the bile bucts. A 67-year-old man had complained of an upper abdominal pain with low grade fever. Direct cholangiography revealed many polypoid lesions mainly in the hepatic ducts after percutaneous biliary drainage. The preoperative diagnosis was biliary papillomatosis. Intraoperative ultrasonography was done. It revealed many isoechoic masses in the right intrahepatic bile ducts. The right hepatic duct and the common hepatic duct. No similar polypoid lesions were found in the left intrahepatic bile ducts. Therefore, extended right hepatic lobectomy with resection of the caudate lobe, the bile duct in the hepatoduodenal ligament, and regional lymphnode dissection were performed. Intraoperative cholangiofiberscopic examination of the hepatic bile duct also demonstrated no residual tumors. Left hepatico-jejunostomy (Roux-en-Y) was performed for biliary reconstraction. Macroscopic examination of the surgical specimen showed many pedunculated papillary polypoid tumors in the whole biliary tract. Histological examination showed papillary adenocarcinoma and lymphnode metastasis in the hepatoduodenal ligament. We emphasize that intraoperative ultrasonographic examination was to detect tumorfree surgical margine of the biliary tree and regional useful lymphnodes dissection for malignant papillomatosis.

Key words
multicentric papillary cholangiocarcinoma, metastasis to lymphnode, intraoperative ultrasonography

Reprint requests
Toshiomi Kusano Department of Surgery, Nagasaki Chuo National Hospital
2-1001-1 Kubara, Omura, 856 JAPAN

Accepted
January 10, 1990

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