A Case of Signet-ring Cell Carcinoma of the Lower Bile Duct

Kouichi Hirokaga, Takashi Hara, Sayuki Yamazaki, Hideaki Kawashima, Masahiro Ishigooka and Yoshio Hosokawa

Department of Surgery, Kin-Ikyo Chuou Hospital

We report a case of signet-ring cell carcinoma originating from the lower bile duct. A 57-year-old man, who had been under treatment for diabetes mellitus, was admitted for hyperglycemia and elevated serous ALP and γ-GTP levels. Abdominal computed tomography showed a mass of 1.5cm in diameter protruding from the pancreatic head to the second portion of the duodenum. Endoscopic retrograde cholangiopancreatography revealed irregular stenosis of the lower bile duct and dilatation of the upper bile duct and main pancreatic duct. Duodenoscopy found a swollen ampulla of Vater. A pancreatoduodenectomy was performed under diagnosis of carcinoma of the ampulla of Vater. Macroscopically, a mass of 1.5cm in diameter of the lower bile duct adjacent to the papilla of Vater was found. Histological examination showed a signet-ring cell carcinoma of the bile duct with severe neural invasion towards the liver, and a well differentiated adenocarcinoma spread on the mucosal layer of the lower bile duct. Because the cut end of the bile duct was cancer positive, intraluminal radiation therapy and extra beam radiation therapy were added. The patient is alive 1 year after the operation. Signet-ring cell carcinoma of the bile duct is very rare, and this type of the bile duct cancer is requires the fine diagnosis and careful treatment.

Key words
extrahepatic bile duct cancer, signet-ring cell carcinoma, neural invasion of bile duct cancer

Reprint requests
Kouichi Hirokaga Department of Surgery, Kobe Kyodo Hospital 2-4-7 Kubo-cho, Nagata-ku, Kobe, 653-0041 JAPAN

Accepted
October 22, 1999

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