Abstract
A 69-year-old man was admitted to our hospital requesting a further examination of the biliary tract because of an elevation of biliary tract enzymes noted at another hospital. On ultrasonography, a marked dilatation of both intra- and extra-hepatic bile ducts and the gall bladder was recognized. A X-ray film taken by endoscopic retrograde cholangiogra-phy (ERC) showed a filling defect with irregular margin in the lateral site of the lower common bile duct. The lesion was observed as a non-ulcerated polypoid lesion with reddish and nodular surface by percutaneous transhepatic cholangioscopy (PTCS). Biopsy speci-mens obtained at the PTCS revealed that the lesion was histologically adenocarcinoma. The tumor was 12 × 10 mm in size in the specimen resected by pancreaticoduodenectomy ; histologically poorly differentiated type of tubular adenocarcinoma invading partly to the pancreas without metastasis to adjacent lymphonodi. No recurrence has not been con-firmed yet for fast 22 months after surgery. Since the lumen of the lower common bile duct ordinarily surrounded by pancreatic tissues is narrow and limited to dilate, a tumor developing in this region easily leads to obstructive jaundice. A case of carcinoma in this region diagnosed in an early stage before appearance of jaundice as presented herein is very rare.
