Two Cases of Primary Cyctic Duct Carcinoma

Akiyoshi Nemoto, Hiromichi Goshima, Shuji Yoshimine, Takashi Higashiguchi, Go Ikeda and Keiko Takagi

Department of Surgery, Owase General Hospital

We recently encountered rare two cases of primary cystic duct carcinoma. Patient 1 was a 67-year-old man admitted for jaundice. Endoscopic nasal biliary drainage tube contrast enhancement shown a 15-mm filling defect at the junction of the common bile duct and cystic duct, leading to a preoperative diagnosis of cancer of the mid-portion of the bile duct. We conducted cholecystectomy and bile duct resection with 2-group lymphadenectomy and anastomosis of the common hepatic duct to the duodenum. A 1-cm nodular-invasive-type mass was found in the cystic duct, and mucin, part of which reached the common bile duct, was observed in the gallbladder. Histologically, the tumor was well-differentiated ductal adenocarcinoma, with no lymph node metastasis. Patient 2 was a 79-year-old man being followed up for diabetes mellitus and admitted when abdominal CT revealed dilation of the intrahepatic bile ducts, stones in the left and right hepatic ducts, and a mass in the cystic duct. Endoscopy showed a cauliflower-like enlargement of the papilla of Vater area, leading a preoperative diagnosis of a tumor of the papilla of Vater and cystic duct, and left and right intrahepatic ducts stones. We conducted pancreatoduodenectomy with 2-group lymphadenectomy. Stones were extracted from the cut end of the common hepatic duct and a pericutaneous transhepatic cholangio-scopy tube was inserted and externalized. A 3-cm exposed mass and a 2.5-cm papillary invasive mass were observed at the papilla of Vater area and from the cystic duct to part of the mid-portion of the bile duct. Histologically, both were well-differentiated ductal adenocarcinomas. Depth of invasion was ss and od, and cystic duct carcinoma metastasis was observed in group 1 lymph nodes.

Key words
primary cystic duct carcinoma, mucin, double cancer

Reprint requests
Akiyoshi Nemoto Department of Surgery, Owase General Hospital 5-25 Ueno-cho, Owase-shi, 519-3693 JAPAN

Accepted
November 27, 2001

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