Abstract
A 64-year-old man presented to a neighborhood hospital with complaints of abdominal pain. He was found to have gallstones and was referred to our hospital for further evaluation and treatment. US examination revealed hypoechoic nodules in the middle bile duct as well as bile duct dilation. Contrast-enhanced CT and MRI scans of the abdomen showed a tumor in the middle and lower bile duct. Based on these findings, the patient was given a diagnosis of middle and lower bile duct carcinoma and underwent pylorus preserving pancreatoduodenectomy. Histopathological examination showed no evidence of anomalous pancreaticobiliary junction but showed two tumors. Specifically, a nodular tumor, measuring 1.5×1.0×0.5 cm, was located in the lower bile duct and a papillary tumor measuring 2.0×1.5×1.0 cm was found in the middle bile duct. Both lesions were tubular adenocarcinomas. There was no histological continuity between the two lesions and only one tumor was immunohistochemically positive for CEA. These findings led to a diagnosis of synchronous multiple cholangiocarcinomas. Herein, we report a very rare case of multiple tumors occurring synchronously in the extrahepatic bile duct with a review of the relevant literature.
