Surgical Case of a Spindle and Giant Cell Type Undifferentiated Carcinoma arising from the Common Bile Duct with Poor Prognosis

Hiroshi Uchinami, Yuki Abe, Kazuhiro Kudo, Makoto Kume, Hiroshi Nanjo* and Yuzo Yamamoto

Department of Gastroenterological Surgery and Department of Pathology*, Akita University School of Medicine

An 80-year-old woman diagnosed with extrahepatic bile duct cancer was found in preoperative imaging to have the lower bile duct obstructed by a tumor and underwent pancreaticoduodenectomy. The tumor was 4×3.5×3 cm in size and showed a flat type with an infiltrating growth pattern macroscopically. Histopatholgically, the tumor consisted mainly of spindle-shaped cells and giant neoplastic cells showed in immunohistochemical staining to be diffusely positive for AE1/AE3, CK7, and vimentin, yielding a diagnosis of undifferentiated spindle and giant cell carcinoma arising from the lower bile duct. Pathological diagnosis was pT4, pN2, M0, fStageIVb. The MIB-1 labeling index was 80%, suggesting high tumor proliferation and a dismal prognosis. CT scan 21 days postoperatively showed multiple liver metastases and lymph node swelling around the superior mesenteric artery. She died of peritonitis and pleuritis carcinomatosa 39 days after surgery. Undifferentiated carcinoma of the common bile duct is extremely rare, and its biological features remain to be clarified beyond the facts of high malignancy and a dismal prognosis.

Key words
undifferentiated carcinoma, spindle and giant cell type, common bile duct

Reprint requests
Hiroshi Uchinami Department of Gastroenterological Surgery, Akita University School of Medicine
1-1-1 Hondo, Akita, 010-8543 JAPAN

Accepted
June 18, 2009

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