Abstract
A 62-year-old man went to the local hospital for obstructive jaundice and acute cholangitis in August 2003. On admission to our hospital, bile juice from naso-biliary drainage tube contained mucin. Abdominal CT revealed a mass in the lower bile duct and a cystic tumor, 3.5cm in diameter, with intracystic solid components in the segment IV of the liver. Cholangiography demonstrated communication between the cystic lesion and the intrahepatic bile duct. Percutaneous transhepatic cholangioscopy showed papillary tumors in the cyst. We diagnosed him as having synchronous biliary double cancer, namely mucin producing intrahepatic cholangiocarcinoma in the segment IV of the liver and lower bile duct cancer. We performed left hepatic lobectomy, caudate lobectomy and pancreaticoduodenectomy in October 2003. Pathologically, the cystic tumor in the liver was papillary adenocarcinoma with mucin-hypersecretion, and lower bile duct mass was well differentiated tubular adenocarcinoma. Non-cancerous bile duct epithelium was existed between two lesions, therefore we finally diagnosed these lesions as double cancer. The patient is still alive without recurrence 15months after surgery. This is the first report of the synchronous double cancer of intrahepatic and extrahepatic cholangiocarcinoma.
