A CASE OF MUCIN-PRODUCING CHOLANGIOCARCINOMA DIAGNOSED PREOPERATIVELY USING PERCUTANEOUS TRANSHEPATIC CHOLANGIOSCOPY

Abstract

A 75-year-old man complaining of right hypochondralgia was admitted to our hospital because of mild jaundice. Duodenal endoscopic findings revealed the yellowish mucin outflow from Vater's papilla. Endoscopic retrograde cholangiography (ERC) revealed the filling defect in the hepatic hilar region and the dilatation extending from the intrahepatic bile ducts into the common bile duct. Obstructive jaundice resulting from mucin-like material retention in the biliary duct was suggested. Percutaneous transhepatic cholangioscopy (PTCS) revealed white tumors associated with yellowish mucin in the left intrahepatic bile duct. The histopathological diagnosis of PTCS biopsy specimens revealed mucin-producing cholangiocarcinoma. He underwent a left lobectomy, and the operative curability was evaluated histologically. Although the mucin-producing cholangiocarcinoma is rare entity, a relatively good prognosis can be promised if it had been accurately diagnosed preoperatively and adequate operation was performed. Conventional cholangiographies such as percutaneous transhepatic cholangiography (PTC) or ERC can not offer precise information of bile ducts because of mucin products. PTCS is indispensable for accurate preoperative diagnosis of mucin-producing cholangiocarcinomaa including the evaluation of superficial spread of cancer, which may improved the prognosis of patients with this disease.