A Case of Adenoendocrine Cell Carcinoma of the Cystic Duct with Concomitant Liver Metastasis

Takahisa Fujikawa, Akira Tanaka, Toshihiro Abe, Yasunori Yoshimoto, Hirokazu Tanaka, Shinsuke Kanekiyo, Seiichiro Tada, Yoshiharu Matsumoto and Tadaaki Yokota*

Department of Surgery and Department of Pathology*, Kokura Memorial Hospital

We report a case of adenoendocrine cell carcinoma of the cystic duct. A 76-year-old man was found in computed tomography (CT) to have a 1.3×1.2 cm polypoid mass at the middle extrahepatic bile duct and a solitary 2×2 cm hepatic mass. Based on a preoperative diagnosis of bile duct and hepatic tumors, we conducted laparotomy with excision of the extrahepatic bile duct, regional lymphadenectomy, and partial hepatectomy. Histopathologically, the tumor, originating in the cystic duct, consisted of solid nests of atypical argyrophilic cells, with differentiated tubular adenocarcinoma partially replacing the mucosa. Immunohistochemical analysis showed positive staining for chromogranin A, synaptophysin, and CD56. The hepatic tumor also consisted of cells with the same characteristics as those in the cystic duct tumor. The definitive diagnosis was adenoendocrine cell carcinoma of the cystic duct with liver metastasis. The man suffered recurrent multiple liver metastases resistant to chemotherapy including gemcitabine and irinotecan, dying 16 months postoperatively. Adenoendocrine cell carcinoma is considered a high-grade malignancy with a dismal prognosis. Effective multidisciplinary treatment including surgery and chemotherapy must therefore be developed against this disease.

Key words
adenoendocrine cell carcinoma, cystic duct, liver metastasis

Reprint requests
Takahisa Fujikawa Department of Surgery, Kokura Memorial Hospital
1-1 Kifune, Kokurakita-ku, Kitakyushu, 803-8555 JAPAN

Accepted
July 22, 2009

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