A Case of Anicteric Early Bile Duct Carcinoma Detected by Magnetic Resonance Cholangiopancreatography

Hiromi Sakaguchi, Hideo Kishimoto, Hideaki Kobayashi, Tomohito Watanabe, Kan Hashikawa, Tsuyoshi Sano^*, Junichi Kamiya^* and Yuji Nimura^*

Department of Surgery, Kami-Iida First General Hospital ^*The First Department of Surgery, Nagoya University School of Medicine

We report a case of early jaundice-free bile duct carcinoma in an 81-year-old woman who had reported abdominal fullness and been found to have liver dysfunction and referred to our hospital. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiography (ERC) showed gall stones and a hemispherical filling defect 18 mm long at the distal bile duct. Duodenoscopic biopsy from the lesion under fluoroscopic guidance showed adenocarcinoma. ERC, peroral cholangioscopy, and intraductal ultrasonography indicated a papillary tumor without superficial mucosal spreading. The patient underwent subtotal stomach-preserving pancreatoduodenectomy with regional lymph node dissection. The resected specimen was a papillary tumor 20×12 mm in the distal bile duct. Histological findings showed moderately differentiated tubular adenocarcinoma invading the fibromuscular layer. Neither lymph node metastasis nor perineural or vascular invasion were found. Post operative recovery was smooth and the patient was discharged on postoperative day (POD) 43. She has remained in good condition in the 1 year and 10 months since, free of signs and symptoms of the recurrence. MRCP thus plays a significant role in early detection of the bile duct carcinoma.

Key words
early bile duct carcinoma, jaundice, MRCP

Reprint requests
Hiromi Sakaguchi Department of Surgery, Kami-Iida First General Hospital 2-70 Kami-iida kita-machi, Kita-ku, Nagoya, 462-0802 JAPAN

Accepted
December 19, 2000

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