A Case of Early Carcinoma Arising from the Cystic Duct

Hideki Hayashi, Hirofumi Miyoshi, Yozo Tsunoda, Hideyo Takeuchi, Takeshi Uematasu*, Yuichi Niwa**

Department of Surgery, Kumagaya General Hospital
*The Second Department of Surgery, Chiba University, School of Medicine
**Department of Clinical Pathology, Kumagaya General Hospital, Niwa Clinic

A 62-year-old man was admitted to our hospital complaining of right upper abdominal pain. Percutaneous transhepatic cholangiography showed an irregular filling defect, presumably at the entry site of the cystic duct, and no visualization of the gallbladder. These findings supported a diagnosis of cystic duct tumor. At laparotomy, a firm nodule was found in the cystic duct. The gallbladder, cystic duct and a segment of the common bile duct were resected with removal of regional lymph nodes, and a Roux-en Y hepaticojejunostomy was performed. Microscopic examination demonstrated a moderately differentiated papillary adenocarcinoma which arose from the cystic duct with infiltration to pm layer and showed growth into the common bile duct intraluminally with no sign of metastasis in the lymph nodes. Although this carcinoma did not satisfy Farrar's criteria for diagnosis of primary carcinoma of the cystic duct, it satisfied the criteria for early carcinoma of the gallbladder which was defined in the General Rules for Surgical and Pathological Studies on Cancer of Biliary Tract. He has remained well for seventy months since his operation, with no evidence of recurrence. The Japanese literature contains reports of 33 cases of the primary carcinoma of the cystic duct. The literature is reviewed.

Key words
primary carcinoma of the cystic duct

Reprint requests
Hideki Hayashi Department of Surgery, Kumagaya General Hospital
4-5-1 Nakanishi, Kumagaya-shi, 360 JAPAN

Accepted
May 11, 1993

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