Abstract
A 69-year-old man was admitted to the hospital complaining of epigastric pain. Dynamic CT showed wall thickening in the lower part of the bile duct, which showed clear enhancement in the early phase, while its border with the pancreatic parenchyma was unclear in the late phase. Dilatation of the main pancreatic duct with no obvious obstruction was also detected. We made the diagnosis of intraductal papillary-mucinous neoplasm of the lower bile duct with infiltration of the pancreas. SSPPD was performed with curative intent.
Examination of the resected specimen revealed that the tumor was located mainly in the lower hepatic bile duct, with a diameter in the major axis of 49mm.
Histopathologically, the tumor cells with eccentrically placed nuclei contained mucus that stained positively with PAS and Alcian blue, consistent with the typical findings of a signet-ring cell carcinoma. The tumor cells diffusely infiltrated the ventral side of the pancreas and the duodenal muscle layer. There were also intraductal papillary-mucinous neoplasms associated with an invasive carcinoma of the pancreatic cervix.
Signet-ring cell carcinoma arises mainly from the stomach, and rarely from the extrahepatic bile duct. It shows diffuse infiltration and a poor prognosis. Our patient developed recurrence six months after the surgery and died 13 months later.
