A Case of Early Gallbladder Cancer Associated with Anomalous Arrangement of the Pancreaticobiliarv Duct with Dilatation of Common Bile Duct -IVB type by Todani's Classification-

Yuichi Nakasato, Nobuyoshi Hanyu, Masaru Naruse¹⁾, Yoichi Ohira²⁾, Kazuhiko Nakayama, Masamichi Otani, Masatoshi Ono, Noburou Miyagawa, Yoshinori Inagaki, Teruaki Aoki

Department of Surgery, Jikei University School of Medicine
¹⁾Departmnet of Surgery, Shimizu Sakuragaoka Hospital
²⁾Department of Surgery, Fuji City Central Hospital

A 58-year-old woman was admitted to the hospital because of abdominal pain and vomiting. Abdominal ultrasonography revealed acute cholecystitis and a protruding lesion. Percutaneous transhepatic gallbladder drainage was undergone. Endoscopic retrograde cholangiopancreatography showed a maximum 20-mm wide diffused type dilatation of the common bile duct, and a 20-mm long cystic dilatation of the common channel, therefore an anomalous arrangement of the pancreaticobiliary duct, IVB type by Todani's classification, was suspected. Cytological findings in bile juice in the gallbladder were class V. Cholecystectomy followed by en bloc wedge resection of the gallbladder bed and lymphadenectomy, resection of the extrahepatic common bile duce and hepato-jejunostomy were performed. The level of amylase in the bile juice in the extrahepatic common bile duct was 86,923 IU/L. Macroscopic examination of resected specimens showed a papillary cancer with an irregular surface mucosa around the mass. Histological findings revealed a papillary adenocarcinoma (ly0, v0) spreading on the Rokitansky-Aschoff sinus (m). In a review of the Japanese literature, only 30 cases of early gallbladder cancer associated with an anomalous arrangement of the pancreaticobiliary duct could be found.

Key words
congenital choledochal cyst, anomalous arrangement of pancreaticobiliary duct, early gallbladder carcinoma

Reprint requests
Yuichi Nakasato Department of Surgery, Jieki University School of Medicine
3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105 JAPAN

Accepted
February 12, 1997

To read the PDF file you will need Abobe Reader installed on your computer.