Two cases of extrahepatic cholangiocarcinoma without jaundice

Abstract

Cholangiocarcinoma presents with jaundice and is often in an advanced stage when it is detected. We report two cases of extrahepatic cholangiocarcinoma without jaundice.
Case 1 : A 70-year-old woman was admitted to our hospital because of fever. Blood analysis revealed the normal level of serum total bilirubin, but elevated hepatobiliary enzymes. Multidetector CT (MDCT) scan revealed a tumor at the lower bile duct. The pathological diagnosis on endoscopic biopsy was papillary adenocarcinoma. Superficially mucosal spreading of carcinoma toward the upper bile duct was not found on peroral cholangioscopy. The patient had pylorus-preserving pancreatoduodenectomy. The depth of cancer invasion was fibromuscular layer on pathological study. Case 2 : A 63-year-old woman was admitted to our hospital because of body weight loss. Blood analysis revealed the serum total bilirubin level of 1.5mg/dl and elevated hepatobiliary enzymes. Abdominal ultrasonography revealed intrahepatic biliary dilatation. MDCT scan revealed a tumor at the hepatic hilus of the bile duct. The cut-line of the bile duct was planned by endoscopic retrograde cholangiography. The patient had extended left hepatectomy, caudate lobectomy and extrahepatic bile duct resection. The pathological diagnosis was moderately differentiated tubular adenocarcinoma with invasion to subserosal layer.
These date suggest that extrahepatic cholangiocarcinoma without jaundice might not be early cancer. A new system is required for early diagnosis of extrahepatic cholangiocarcinoma to improve the prognosis.