A Case of Common Bile Duct Carcinoma Diagnosed During Follow-up in a Case of Congenital Biliary Dilatation

Abstract

We diagnosed common bile duct carcinoma during follow-up in a case of congenital biliary dilatation. A 63-year-old man was incidentally detected to have biliary dilatation on computed tomography (CT) performed for investigating the cause of left back pain. Both magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography demonstrated pancreatobiliary maljunction associated with the biliary dilatation. Although we recommended surgery, the patient refused, and we followed up the patient periodically. One year seven months later, enhanced abdominal CT and MRCP showed a tumor in the hilar portion of the common bile duct. The patient was diagnosed as having cholangiocarcinoma, and pancreaticoduodenectomy was performed. The histopathological diagnosis was poorly differentiated tubular adenocarcinoma (T2aN0M0, Stage Ⅱ, R0). He received adjuvant chemotherapy with S-1. Six months later, enhanced abdominal CT showed a local recurrence and lymph node metastasis around the celiac artery. Treatment with gemcitabine plus cisplatin was started, however, the patient showed poor response and died of the cancer 18 months after surgery. This case report is intended to emphasize the importance of early surgery for congenital biliary dilatation, especially in elderly patients.