A Case of Primary Sclerosing Cholangitis with Gallbladder Carcinoma Showed Remarkable Stricture of the Bile Duct

Makoto Yoshida¹⁾²⁾, Takashi Hara²⁾, Setsuji Takanashi²⁾, Masahiro Ishigo-oka¹⁾, Motoya Kashiyama¹⁾ and Hideaki Kawashima¹⁾

¹⁾Department of Surgery, Kin-ikyo Sapporo-Nishiku Hospital
²⁾Department of Surgery, Kin-ikyo Chuo Hospital

A 78-year-old woman admitted for cholecystitis with gallstones in August 1999 was found in endoscopic retrograde cholangiopancreatography (ERCP) to have a dilated extrahepatic bile duct 18 mm in diameter. She had been admitted elsewhere for cholangitis in December 2000. ERCP showed extensive stricture of extrahepatic bile duct without bile duct calculus and segmental stricture of intrahepatic bile duct. Given her general condition, no further examination was done. She was seen for abdominal pain and vomiting and was admitted for a thorough examination in May 2002. ERCP showed severe and extensive stricture of extrahepatic bile duct similar to a thread and diverticulum-like outpouchings and segmental stricture of intrahepatic bile duct (B3 and B8). Under a diagnosis of primary sclerosing cholangitis, we conducted laparoscopic cholecystectomy with liver biopsy. We found 2 gallstones and a slight torous epithelial lesion 2.8×1.5 cm on the gallbladder. Histopathological diagnosis was well-differentiated tubular adenocarcinoma of the gallbladder confined to the mucosa. The postoperative course was uneventful, involving oral administration ursodeoxycolic acid at 300 mg per day. Regular checkups have shown no recurrence of carcinoma or jaundice during follow-up, and no change has been seen in the bile duct.

Key words
sclerosing cholangitis, gallbladder carcinoma, bile duct dilation

Reprint requests
Makoto Yoshida Department of Surgery, Kin-ikyo Chuo Hospital
10-2 Fushiko, Higashi-ku, Sapporo, 007-8505 JAPAN

Accepted
May 25, 2004

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