Abstract
A 72-year-old man complaining of fever and abdominal pain was performed emergency endoscopic transnasal biliary drainage (ENBD) with a diagnosis of obstructive cholangitis at another hospital. As a result, no findings of stones or stricture in the common bile duct were seen, but the cystic duct was not visualized. The patient was thus referred to our hospital for further close exploration and treatment. An abdominal multi-detector row CT (MDCT) scan showed a tumorous lesion with faint enhancement effect only in the cystic duct, but no stones and tumor lesions were proved in the gallbladder. Endoscopic retrograde cholangiography (ERC) showed a filling defect at the joint portion, and abrasive cytology of the same site offered a diagnosis of adenocarcinoma. Intra-ductal ultrasonography showed a tumorous lesion which looked like to fill the cystic duct, and a part of the lesion had protruded into the common bile duct but no progression to the bile duct was demonstrated. Cholecystectomy, resection of the extrahepatic bile duct and lymph node dissection (D2) were performed with the preoperative diagnosis of cystic duct carcinoma. The pathological diagnosis was papillary adenocarcinoma, depth of fm patCGnBm, INFβ, ly0, v0, pn0, pHinf0, pBinf0, pPV0, pA0, pN0, pHM0, pBM0, and EM0. It was early cystic duct carcinoma. The patient has been doing well as of 17 months after the opration.
