Cystic Duct Remnant Cancer-A Case Report

Koji Morimoto, Atsuyuki Maeda, Hideyuki Kanemoto, Kazuya Matsunaga, Katsuhiko Uesaka, Etsuro Bando*, Shuji Saito* and Ichiro Ito**

Divisions of Hepato-Biliary-Pancreatic Surgery, Department of Digestive Surgery* and Department of Pathology**, Shizuoka Cancer Center Hospital

We report an extremely rare case of carcinoma arising in the remnant cystic duct. A jaundiced 70-year-old man who underwent cholecystecomy and choledochotomy four years ago for cholecystitis and choledocholithiasis was found in abdominal computed tomography (CT) to have a tumor 3.3 cm in diameter at the hepatic hilum with biliary invasion and duodenal involvement. The upper bile duct was invaded from the right side with intrabiliary growth. Cholangiography showed a filling defect at the right side of the upper bile duct, consistent with intrabiliary growth. The cystic duct remnant was not opacified by contrast medium. We diagnosed the patient as having carcinoma arising in the remnant cystic duct, based on his history and precise interpretation of diagnostic imaging. The patient underwent right hepatectomy, caudate lobedtomy, bile duct resection, and reconstruction. The resected specimen was a whitish tumor with a diameter of 3.0 cm. The tumor consisted predominantly of extrabiliary tubular adenocarcinoma and intrabiliary growth (papillary adenocarcinoma). In the midst of the cancer, a silk blade was identified, suggesting the origin of the tumor to be the cystic duct remnant. The patient underwent surgery twice for recurrent tumors and remains alive two years and nine months after initial surgery without evidence of recurrence.

Key words
cystic duct remnant, bile duct cancer, gallbladder cancer

Reprint requests
Koji Morimoto Divisions of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital
1007 Nagaizumi, Sunto-gun, 411-8777 JAPAN

Accepted
June 27, 2007

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