A Case of Mucinous Cholangiocarcinoma with an Early Gastric Remnant Cancer Developed after Operations for an Early Gastric Cancer and a Bile Duct Cancer

Shinsuke Matsuda, Masanobu Usui, Hideaki Suzuki, Yoshifumi Ogura¹⁾ and Taizou Shiraishi²⁾

Department of Surgery, Nagai General Hospital
Department of Surgery, Matsusaka City Hospital¹⁾
Second Department of Pathology, Mie University²⁾

We report a case of quadruple cancer of 3 organs in which mucinous cholangiocarcinoma and gastric remnant cancer developed pastoperatively for early gastric cancer and bile duct cancer. A 69-year-old man had undergone distal gastrectomy for early gastric cancer at age 54 (IIc tumor, moderately differentiated tubular adenocarcinoma, m), and hilar hepatectomy with caudate lobectomy for bile duct cancer at age 63 (papillary tumor, 2.0×2.0 cm, well-differentiated tubular adenocarcinoma, ss, n0, stage II). He was admitted for anterior chest and upper abdominal discomfort and an increase in serum CA19-9. Early gastric cancer detected at the remnant stomach necessitated endoscopic mucosal resection (0-1 type, well-differentiated tubular adenocarcinoma, m). US, CT, and MRI showed a tumor from the lateral segment of the liver to the anterior mediastinum. Preoperative diagnosis was liver metastasis of bile duct cancer, necessiatating lateral segmentectomy with partial resection of the diaphragm, sternum, and pericardium. Macroscopic findings showed a tumor 7.0×5.0 cm with a yellowish-white lobular cut surface. The pathological diagnosis was mucinous cholangiocarcinoma (T2: diaphragm, sternum, pericardium, N0, M0, Stage III). He died 7 months after the last operation due to multiple bone metastases.

Key words
quadruple cancer, cholangiocellular carcinoma, mucinous cholangiocarcinoma

Reprint requests
Shinsuke Matsuda Department of Surgery, Nagai General Hospital
29-29 Nishimarunouchi, Tsu, 514-0035 JAPAN

Accepted
February 23, 2005

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