原発性胆嚢管癌の2例

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  • Two Cases of Primary Cyctic Duct Carcinoma

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We recently encountered rare two cases of primary cystic duct carcinoma. Patient 1 was a 67-year-old man admitted for jaundice. Endoscopic nasal biliary drainage tube contrast enhancement shown a 15-mm filling defect at the junction of the common bile duct and cystic duct, leading to a preoperative diagnosis of cancer of the mid-portion of the bile duct. We conducted cholecystectomy and bile duct resection with 2-group lymphadenectomy and anastomosis of the common hepatic duct to the duodenum. A 1-cm nodular-invasivetype mass was found in the cystic duct, and mucin, part of which reached the common bile duct, was observed in the gallbladder. Histologically, the tumor was well-differentiated ductal adenocarcinoma, with no lymph node metastasis. Patient 2 was a 79-year-old man being followed up for diabetes mellitus and admitted when abdominal CT revealed dilation of the intrahepatic bile ducts, stones in the left and right hepatic ducts, and a mass in the cystic duct. Endoscopy showed a cauliflower-like enlargement of the papilla of Vater area, leading a preoperative diagnosis of a tumor of the papilla of Vater and cystic duct, and left and right intrahepatic ducts stones. We conducted pancreatoduodenectomy with 2-group lymphadenectomy. Stones were extracted from the cut end of the common hepatic duct and a pericutaneous transhepatic cholangio-scopy tube was inserted and externalized. A 3-cm exposed mass and a 2.5-cm papillary invasive mass were observed at the papilla of Vater area and from the cystic duct to part of the mid-portion of the bile duct. Histologically, both were well-differentiated ductal adenocarcinomas. Depth of invasion was ss and od, and cystic duct carcinoma metastasis was observed in group 1 lymph nodes.

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