A Case of Ampullary Cholangiocarcinoma with Dudodenal Stenosis as the Initial Manifestation

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  • 十二指腸狭窄を初発症状とした乳頭部胆管癌の1例
  • ジュウニシチョウ キョウサク オ ショハツ ショウジョウ ト シタ ニュウトウブタンカン ガン ノ 1レイ

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Abstract

<p>Jaundice is a typical first symptom of duodenal papillary carcinoma and there has been no previously reported case of duodenal stenosis as its initial manifestation. Here the rare case of a patient with duodenal papillary carcinoma who presented with duodenal stenosis is reported. A 57-year-old woman was referred to our hospital with vomiting, and routine examination showed no evidence of malignancy. However, she came back and was eventually admitted with complete duodenal obstruction. Abdominal contrast-enhanced computed tomography (CT) showed thickening of the duodenal submucosa and stenosis of its descending portion. The bile duct and main pancreatic duct were not dilated. Malignancy was not definitively diagnosed, gastrojejunal bypass was performed for the duodenal obstruction. Two months after surgery, however, she was readmitted with obstructive jaundice. Multiple biopsies and bile cytology still showed no evidence of malignancy, but since the possibiliry of a malignant tumor could not be excluded, subtotal stomach-preserving pancreatoduodenectomy was performed. Postoperative histopathological diagnosis revealed highly differentiated adenocarcinoma located mainly in the ampullary bile duct, and from the findings of the immunostaining results, ampullary cholangiocarcinoma was diagnosed.</p>

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