Abstract
A 68-year-old man was admitted to the hospital because of jaundice. Serum total bilirubin level was elevated to 13.6mg/dl. An abdominal CT scan showed the dilatation of the intrahepatic bile duct and the common bile duct (CBD). Cholangiography of percutaneous transhepatic biliary drainage (PTBD) showed a complete obstruction of the distal part of the CBD. Cytology of bile juice from PTBD tube was class I, and serum CEA, CA19-9, and DUPAN-II levels were within normal limits. However, malignancy of the distal bile duct was strongly indicated and pylorus-preserving pancreatoduodenectomy (PpPD) was performed. After the operation, histological examination revealed that the tumor was composed of both a part of cancerous tubular structure and a part showing transition to sarcomatous spindle cells. On immunohistochemical stainings, both epithelial and non-epithelial portions were positive for keratin and cytokeratin, and positive stain to vimentin was also observed in non-epithelial portion, showing so-called carcinosarcoma. Pathological TNM grading (UICC) was pT3 (pancreas) pN2 (peripancreatic) M0, stage IVA. During follow-up period, an abdominal CT scan revealed multiple liver metastases 4 months after the operation. The patient died 8 months after the operation.
Carcinosarcoma of the CBD is so rare that only 19 cases have been reported in the Japanese literature as far as we could review.
