A Case of Synchronous Double Cancer of Mucin Producing Intrahepatic Cholangiocarcinoma and Lower Bile Duct Carcinoma

Hideyuki Kanemoto, Katsuhiko Uesaka, Atsuyuki Maeda, Kazuya Matsunaga, Shigeki Yamaguchi¹⁾ and Tsuyoshi Shoji²⁾

Division of Hepato-Biliary-Pancreatic Surgery and Division of Digestive Surgery¹⁾, Shizuoka Cancer Center Division of Surgery, Kanbara Municipal Hospital²⁾

A 62-year-old man went to the local hospital for obstructive jaundice and acute cholangitis in August 2003. On admission to our hospital, bile juice from naso-biliary drainage tube contained mucin. Abdominal CT revealed a mass in the lower bile duct and a cystic tumor, 3.5 cm in diameter, with intracystic solid components in the segment IV of the liver. Cholangiography demonstrated communication between the cystic lesion and the intrahepatic bile duct. Percutaneous transhepatic cholangioscopy showed papillary tumors in the cyst. We diagnosed him as having synchronous biliary double cancer, namely mucin producing intrahepatic cholangiocarcinoma in the segment IV of the liver and lower bile duct cancer. We performed left hepatic lobectomy, caudate lobectomy and pancreaticoduodenectomy in October 2003. Pathologically, the cystic tumor in the liver was papillary adenocarcinoma with mucin-hypersecretion, and lower bile duct mass was well differentiated tubular adenocarcinoma. Non-cancerous bile duct epithelium was existed between two lesions, therefore we finally diagnosed these lesions as double cancer. The patient is still alive without recurrence 15 months after surgery. This is the first report of the synchronous double cancer of intrahepatic and extrahepatic cholangiocarcinoma.

Key words
cholangiocarcinoma, synchronous double cancer, hepatobiliary cystadenocarcinoma

Reprint requests
Hideyuki Kanemoto Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center
1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, 411-8777 JAPAN

Accepted
April 27, 2005

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