Abstract
A 67-year-old man visited our department for treatment after developing epigastric pain. Imaging tests revealed dilation of the intrahepatic bile duct and common bile duct, as well as wall thickening of the cystic duct. Endoscopic retrograde cholangiopancreatography (ERCP) confirmed release of a large amount of green, jelly-like mucus from the papillae of Vater. In addition, peroral cholangioscopy (POCS) showed green mucus in the opening of the cystic duct, and bile cytology was Class V (adenocarcinoma). No clear abnormalities were found on the mucosal surface of the bile duct. Based on the above, the patient was diagnosed with a mucin-producing carcinoma of the cystic duct, and he underwent cholecystectomy with partial resection of the liver bed, resection of the extrahepatic bile duct, D2 lymph node dissection, and choledochojejunostomy. Circumferential, poorly-defined wall thickening with a papillary surface was observed in the cystic duct, and the gallbladder was filled with viscous, green, jelly-like mucus. The histological diagnosis was well-differentiated adenocarcinoma with an invasion depth of ss, with no lymph node metastasis, and the tumor was stage II.
The patient for whom preoperative diagnosis of mucin-producing carcinoma of the cystic duct was made based on POCS is reported.
