2023 Volume 56 Issue 3 Pages 154-164
Bile duct metastasis is extremely rare as a cause of biliary stenosis in patients with distant metastases from gastric cancer. The patient was a 71-year-old male who underwent distal gastrectomy for synchronous gastric cancers in January 2014, and remnant gastrectomy for gastroesophageal cancer in March 2020. In October 2020, the patient was referred to our hospital due to a hilar bile duct tumor and intrahepatic bile duct dilation. Enhanced CT showed circumferential stenosis of the hilar bile duct, which was classified as Bismuth IV. A biopsy of the hilar bile duct tumor did not show malignant findings, but the patient was diagnosed with unresectable perihilar cholangiocarcinoma based on the imaging findings, and chemotherapy was administered for 6 months. Due to a marked decrease of tumor markers and tumor shrinkage, conversion surgery was planned, and left hepatectomy and caudate lobectomy with combined resection of the portal vein were performed. Pathologically, the tumor was diagnosed as a poorly differentiated adenocarcinoma and signet-ring cell carcinoma that grew mainly around the bile duct, similar to the gastroesophageal cancer specimen. There was no dysplasia of the bile duct mucosal epithelium, so the patient was diagnosed with bile duct metastasis from gastroesophageal cancer. Three months after surgery, the patient died of sepsis from cholangitis due to biliary anastomosis stenosis caused by local recurrence.
