A Case of Distal Common Bile Duct Carcinoma Which was Daiagnosed as Adenoma 5 Years Ago

Kenji Kobayashi, Kenzo Yasui, Mitsunori Yasue, Seiichi Miyaishi, Hiroaki Nakazato, Kanji Miyata*, Kakuya Ishikawa*, Tatsuo Hattori*

Department of Gastroenterological Surgery, Aichi Cancer Center Hospital
*Department of Surgery, Nagoya First Red Cross Hospital

A 51-year-old man who underwent choledocholithotomy in 1985 was admitted to a nearly hospital complaining of epigastralgia in January 1990. In 1985 an adenoma was found in the distal common bile duct after the choledocholithotomy. In January 1990, epigastralgia occurred again, and so percutaneous transhepatic cholangio drainage was performed and the size and shape of the tumor were not changed obviously. A biopsy of the tumor using a snare revealed papillary adenoma with severe atypia. A pancreaticoduodenectomy was carried out for three reasons: first, the tumor might have malignant potential; second, the tumor was irregular polypoid lesion and third the clinical symptom was caused by this tumor. The final histopathological examination revealed papillary adenocarcinoma of the bile duct with invasion to the fibromascular layer. The diagnostic and therapeutic problems with a tumor in the distal bile duct are discussed from this experience.

Key words
slow growing adenocarcinoma of the distal bile duct, bile duct adenoma with severe atypia, indication of pancreaticoduodenectomy

Reprint requests
Kenji Kobayashi Department of Gastroenterological Surgery, Aichi Cancer Center Hospital
1-1 Kanokoden, Chikusa-ku, Nagoya, 464 JAPAN

Accepted
March 13, 1991

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