A Case of Adenosquamous Carcinoma arising in the Intrapancreatic Remnant Bile Duct after Excision of Congenital Biliary Dilation with Synchronous Triple Carcinomas of the Papilla of Vater and the Duodenum

Hiroyoshi Sendo, Tohru Nishimura, Yoshiki Nakamura, Kunihiko Kaneda, Takahiro Wada and Tomohiko Kizaki*

Department of Surgery and Department of Pathology*, Sanda Municipal Hospital

A 68-year-old man admitted for right upper abdominal and back pain had undergone cholecystectomy in 1966 and congenital biliary dilation excision with hepaticojejunostomy by Roux-Y anastomosis in December 1998. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) showed a 45 mm tumor in the pancreas head but no pancreatic duct dilation. ERCP showed a cystic lesion communicating with the remnant bile duct. Abdominal angiography showed hypervascular tumor staining. We conducted pancreaticoduodenectomy based on a diagnosis of cholangiocarcinoma arising in the intrapancreatic remnant bile duct. Histopathologically, adenosquamous carcinoma originated from the intrapancreatic remnant bile duct, with synchronous carcinoma of the papilla of Vater and the duodenum. None of the three carcinomas were connected. This is, to our knowledge, the first report of adenosquamous carcinoma arising in the intrapancreatic remnant bile duct after congenital biliary dilation excision accompanied by synchronous triple carcinomas consisting of intrapancreatic cholangiocarcinoma, carcinoma of the papilla of Vater, and duodenal carcinoma.

Key words
adenosquamous carcinoma, intrapancreatic cholangiocarcinoma, congenital biliary dilation

Reprint requests
Hiroyoshi Sendo Department of Surgery, Sanda Municipal Hospital
3-1-1 Keyakidai, Sanda, 669-1321 JAPAN

Accepted
February 28, 2007

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