A Case of Mucin-Producing Carcinoma of the Pancreas with Mucinous Biliary Obstruction

Hideto Sakimoto, Michinori Arita, Yasutomo Ojima, Hideki Nakahara, Yoshiteru Ogawa, Yoshinori Kuroda, Fumiaki Hino*, Toshihiro Kobuke**, Syuji Yonehara***

Department of Surgery, Onomichi General Hospital
*Department of Internal Medicine, Onomichi General Hospital
**Department of Pathology, Onomichi General Hospital
***The Second Department of Pathology, Hiroshima University School of Medicine

Mucin-producing pancreatic cancer has been reported by many authors in recent years, but only a few cases of mucous occlusive jaundice have been described. We experienced mucin-producing pancreatic cancer from which mucin leaked through a fistula to the common bile duct and caused jaundice. The patient was a 73-year-old man, who visited our clinic with right hypochondralgia and jaundice. Abdominal ultrasonography and abdominal computed tomography showed prominent dilatation of the common bile duct and pancreatic duct with a protruded mass inside. Percutaneous transhepatic cholangiography revealed hypertransradiancy within the lower common bile duct, through which an outflow of bile with an admixture of a great deal of jelly-like material was found by drainage. The diagnosis of mucin-producing pancreatic cancer was thus established and total pancreatectomy was done. Microscopic examination showed papillary adenocarcinoma diffusely proliferated along the main pancreatic duct and the presence of a fistula between the main pancreatic duct and the common bile duct. We thought that the pressure inside the pancreatic duct by excessive mucin made the fistula to the common bile duct. Only 15 cases of mucin-producing pancreatic carcinoma presenting breakage into the common bile duct have so far been reported in Japan. We believe that this case is very suggestive in elucidating the developmental mechanism of mucin-producing pancreatic cancer.

Key words
mucin-producing carcinoma of the pancreas, bilio-pancreatic fistula, mucinous biliary obstruction

Reprint requests
Hideto Sakimoto Department of Surgery, Onomichi General Hospital
7-19 Kohama-cho, Onomichi, 722 JAPAN

Accepted
February 13, 1991

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