2017 Volume 50 Issue 5 Pages 393-400
A 49-year-old woman had undergone CT as a periodic checkup for breast cancer. CT revealed dilatation of the bile duct. She was given a diagnosis of bile duct cancer and gallbladder cancer with pancreaticobiliary maljunction and underwent pylorus-preserving pancreatoduodenectomy. The histopathological diagnosis was adenocarcinoma of the extrahepatic bile duct (T1 N0 M0 Stage I) and gallbladder adenocarcinoma (T1 N0 M0 Stage I). Eighteen months later, CT revealed a hypovascular tumor at the remnant pancreas. The patient was suspected to have remnant pancreatic cancer and underwent total remnant pancreatectomy. Histological sections of the resected specimens showed an irregular arrangement of many white tumors in the remnant pancreas. The uniform atypia of the pancreatic duct exhibited a papillary epithelium. Immunohistochemical analysis showed identical profiles between the remnant pancreatic tumor and the extrahepatic bile duct tumor. Therefore, we diagnosed recurrent bile duct carcinoma at the remnant pancreas. These findings suggest that the extrahepatic bile duct tumor cells disseminated to the pancreatic ducts through the common duct of the pancreaticobiliary maljunction. This is the first known reported case of this condition. Physicians must keep in mind the possibility of dissemination of bile duct carcinoma with pancreaticobiliary maljunction to the remnant pancreas through the common duct.
