Abstract
A 61-yr-old woman was admitted to our hospital with complaints of jaundice and intermittent pain in the right upper abdomen. Ultrasonogram showed multiple stones and debris in the distended gallbladder, and a dilation of the common bile duct (CBD). The diagnosis of obstructive jaundice was then made. After that, endoscopic nasobiliary drainage and endoscopic sphincterotomy were performed, and a stone was removed from CBD. Cholangiography demonstrated an obstruction of the cystic duct, and non-visualization of the gallbladder. EUS demonstrated a dilatation of CBD and a papillary lesion at the site of the obstruction. However, PCS and brushing cytology could give a definite diagnosis of carcinoma in the cystic duct. Multiple stones in the enlarged gallbladder and a tumor in the cystic duct were found after laparotomy. Extended cholecystectomy and lymphadenectomy were carried out and a T-tube was inserted. Combination of EUS, PCS, and transpapillary biopsy and cytology is thought to be very useful to make a differential diagnosis of obstruction of the cystic duct. In this case, although the main tumor seemed to be in the cystic duct of the gallbladder macroscopically, however in a pathological viewpoint, adenocarcinoma had invaded a large part of the gallbladder and the depth of tumor invasion had been limited to the subserous layer.
