Abstract
A 58-year-old woman was admitted to the hospital because of abdominal pain and vomiting. Abdominal ultrasonography revealed acute cholecystitis and a protruding lesion. Percutaneous transhepatic gallbladder drainage was undergone. Endoscopic retrograde cholangiopancreatography showed a maximum 20-mm wide diffused type dilatation of the common bile duct, and a 20-mm long cystic dilatation of the common channel, therefore an anomalous arrangement of the pancreaticobiliary duct, IVB type by Todani's classification, was suspected. Cytological findings in bile juice in the gallbladder were class V. Cholecystectomy followed by en bloc wedge resection of the gallbladder bed and lymphadenectomy, resection of the extrahepatic common bile duce and hepato-jejunostomy were performed. The level of amylase in the bile juice in the extrahepatic common bile duct was 86, 923 IU/L. Macroscopic examination of resected specimens showed a papillary cancer with an irregular surface mucosa around the mass. Histological findings revealed a papillary adenocarcinoma (ly0, v0) spreading on the Rokitansky-Aschoff sinus (m). In a review of the Japanese literature, only 30 cases of early gallbladder cancer associated with an anomalous arrangement of the pancreaticobiliary duct could be found.
