A Case of Synchronous Double Early Cancers in the Extrahepatic Biliary Tract Died of Lymphnode Recurrence 3 Years after a Successful Resection

Tetsuo Ajiki, Hirohiko Onoyama, Isamu Yamada, Tatsuo Sako, Iwao Yamazaki, Masahiro Yamoto, Yoichi Saito, Takahiro Fujimori*

First Department of Surgery and *Second Department of Pathology, Kobe University School of Medicine

We report a case of synchronous double early cancers in the extrahepatic biliary tract of a patient who died of lymphnode recurrence 34 months after surgical resection. A 70-year-old man was admitted because of a papillary tumor of the common bile duct. Pancreatoduodenectomy was performed under a diagnosis of bile duct carcinoma. By mapping the whole biliary tract, papillary adenocarcinoma confined to the fibromuscular layer of the bile duct and well-differentiated adenocarcinoma limited to the mucosal layer of the gallbladder were diagnosed with histological examination. The tumors, which were completely separated, showed no vessel invasion and no lymphnode metastasis. The biological behavior of the tumors as determined by immunohistochemical staining with CEA and CA19-9 was different. Vessel invasion is known to be rare among patients with early carcinoma of the biliary tract, whose prognosis is usually favorable. However, this patient died of recurrence, although both tumors were confirmed as double early carcinomas by mapping the whole biliary tract.

Key words
double cancer, biliary tract carcinoma, lymphnode metastasis of early carcinoma

Reprint requests
Testuo Ajiki First Department of Surgery, Kobe University School of Medicine
7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650 JAPAN

Accepted
December 7, 1994

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