A Case of Primary Cystic Duct Carcinoma Based on Farrar's Criteria Necessitating Additional Resection Because of Difficult Preoperative Diagnosis

Takahisa Hiramitsu, Jiro Nagata, Eiji Ohnishi, Kenichi Nakanishi, Hisaharu Ohya, Tetsuo Nishi, Takahiro Mase, Shingo Kawasaki and Shyoji Hasimoto

Department of Surgery, Ichinomiya Municipal Hospital

A 70-year-old man with epigastralgia and right upper quadrant pain was found in ultrasonography showed gall bladder swelling and debris. ERCP did not evidence the cystic duct or gall bladder. Gastrointestinal endoscopy showed type 1 gastric cancer on the posterior wall of the gastric angle necessitating distal gastrectomy and cholecystectomy. The histological diagnosis was cystic duct carcinoma. We later resected the cystic duct and a segment of the common bile duct and removed regional lymph nodes, followed by Roux-en-Y hepaticojejunostomy. Microscopic examination showed no carcinoma or no lymph nodes metastasis. This carcinoma met Farrar's criteria for primary cystic duct carcinoma. The man has remained well in the 2 years since his operation. The Japanese literature reports 37 cases of primary cystic duct carcinoma.

Key words
primary carcinoma of the cystic duct, Farrar's criteria, gall bladder carcinoma

Reprint requests
Takahisa Hiramitsu Department of Surgery, Ichinomiya Municipal Hospital
2-2-22 Bunkyo, Ichinomiya, 491-8558 JAPAN

Accepted
March 25, 2009

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