A Case of Lower Bile Duct Cancer Associated with Pancreaticobiliary Maljunction without Bile Duct Dilation after Operation of a Gallbladder Cancer

Michihiro Ishida, Takefumi Niguma, Takurou Yukawa, Tetsushige Mimura and Masanobu Tsutsui

Department of Surgery, Okayama Saiseikai General Hospital

We report a rare case of pancreaticobiliary maljunction without bile duct dilation associated with lower bile duct cancer after operation of gallbladder cancer. A 57-year-old woman admitted for suspected gallbladder cancer, was found in magnetic resonance imaging to have a hypertrophied heterogeneous gallbladder wall and pancreaticobiliary maljunction without bile duct dilation. Under a diagnosis of gallbladder cancer with pancreaticobiliary maljunction without bile duct dilation, she underwent surgery and was pathologically diagnosed postoperatively with gallbladder cancer, SS, N0 Stage II sCurA. Twelve months later, her DUPAN-2 elevated and continued to increased. PET computed tomography showed accumulation in the pancreas head and MRI a mass 20 mm in diameter in the intrapancreatic bile duct. Eighteen months later, a malignant tumor of the bile duct necessitated pylorus-preserving pancreaticoduodenectomy. Pathological findings indicated that tumor cells had expanded flatly to the bile duct epithelium, leading to a diagnosis of primary adenocarcinoma of the bile duct. Many reports have mentioned pancreaticobiliary maljunction without bile duct dilation was frequently accompanied by gallbladder cancer, but bile duct cancer is rare.

Key words
pancreaticobiliary maljunction, bile duct cancer, gallbladder cancer

Reprint requests
Michihiro Ishida Department of Surgery, Okayama Saiseikai General Hospital
1-17-18 Ifukucho, Okayama, 700-8511 JAPAN

Accepted
February 28, 2007

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