Abstract
Presented here is the case of a 56-year-old woman with mucin-producing cholangiocarcinoma which we missed at the first surgery. She visited out hospital with the chief complaints of jaundice and fever. Ultrasound (US) and Endoscopic retrograde cholangiography (ERC) revealed a markedly dilated common bile duct and dilated left intrahepatic bile ducts, and a defect in the common bile duct. Based on the above findings, surgery was performed under the diagnosis of choledocholithiasis. At incision of the common bile duct, a large amount of jelly-like substance was excreted, but choledochoscopy failed to reveal abnormal findings in the common bile and intrahepatic bile duct. Postoperatively, the bile and jelly-like substance were drained continuously via a T-tube, but cytology of the bile provided no finding of malignant cells. Choledochoscopy via the T-tube demonstrated a papillary tumorous lesion in the left hepatic duct, and a diagnosis of papillary adenocarcinoma was established by biopsy. Therefore, resection of the left lobe of the liver, left caudate lobe and extrahepatic bile duct was performed. Cystic dilatation of the intrahepatic bile duct was observed on the resected specimen, but the induration and tumor were not palpable. The histopathological diagnosis was mucin-producing cholangiocarcinoma of the intrahepatic bile duct.
