A Case of Non-icteric Early Bile Duct Carcinoma

Masayoshi Nagahama, Masato Furukawa, Toshinori Nakata, Tsutomu Sakai, Kosei Miyashita, Yoshikazu Mine, Makoto Sasaki, Satoshi Kondo, Yukihiro Okuhama, Takahiro Yasaka, Takaaki Nakahira

Department of Surgery, Nagasaki Chuo National Hospital

Bile duct carcinoma is difficult to diagnose in the early stage. We present a case of non-icteric early bile duct carcinoma in the mucosal layer, 35×50 mm in size. The patient, an 82-year-old woman, was admitted to our hospital. She complained of nausea and had liver dysfunction (elevation of LAP and γ-GTP) without jaundice. The findings of abdominal ultrasonography (US) of this patient were dilatation of the extra-hepatic bile duct and a mass lesion in the middle bile duct. Percutaneous transhepatic cholangiography (PTC) showed a 45 mm filling defect in the middle bile duct, indicating incomplete obstruction. Laparotomy was performed. Among the peritoneal findings, we could not detect ascites or lymph node swelling. Resection of the gallbladder and extra-hepatic bile duct, and hepaticojejunostomy (Roux-en-Y) were done. The size of the tumor was 35×50 mm. Pathological analysis after surgery revealed papillary tumor of the bile duct, which was characterized as papillary adenocarcinoma, well differentiated, located in the mucosal layer (Bm-Bs-C, m, hinf₀, ginf₀, n1(-), Stage I). She has been well for 13 months after surgery and is without recurrence.

Key words
early bile duct carcinoma, no jaundice, papillary adenocarcinoma

Reprint requests
Masayoshi Nagahama Department of Surgery, Nagasaki Chuo National Hospital
2-1001-1 Kubara, Omura City, 856 JAPAN

Accepted
December 6, 1995

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