A case of cholangiocarcinoma with pancreaticobiliary maljunction without dilation of the bile duct after early gallbladder cancer resection

Abstract

A 72-year-old woman had a cholecystectomy in December 2006 for early gallbladder cancer accompanied by a pancreaticobiliary maljunction without bile duct dilation. Histopathological findings revealed papillary adenocarcinoma (Tis, N0, M0, stage 0). She was admitted due to obstructive jaundice in April 2010. Under the diagnosis of middle and inferior common bile duct cancer, a subtotal stomach-preserving pancreatoduodenectomy was performed. Histopathological findings revealed papillary adenocarcinoma (T3, N0, M0, stage IIA). The resection and reconstruction of the extrahepatic bile duct in addition to cholecystectomy for pancreaticobiliary maljunction without bile duct dilation remains controversial. In this case, dysplastic changes were seen in the epithelium of the common channel in that the lower side of the pancreaticobiliary junction was invaded by cancer cells. Therefore, resection of the extrahepatic bile duct would not have removed all of the area with malignant potential, even if it had been performed at the time of the first surgery.