Abstract
A 75-year-old male presented with jaundice and generalized malaise. Abdominal CT showed upper and lower bile duct masses. MRCP showed filling defects from the right/left hepatic duct bifurcation to the upper bile duct, and in the lower bile duct. Exfoliative cytology of the lower bile duct revealed Group V, adenocarcinoma. The patient was therefore diagnosed as having bile duct cancer in the hepatic portal region and lower bile duct. Percutaneous transhepatic portal vein embolization was performed. Two weeks later, hepatectomy of two segments of the right lobe segments and pancreaticoduodenectomy (modified Child method reconstruction) were performed. In the resected specimens, the papillary tumor in the hepatic portal region was adjacent to the nodular infiltrating tumour in the lower bile duct. Histopathologically, the hepatic portal region tumour was diagnosed as endocrine cell carcinoma showing an extremely solid growth of small atypical cells with high nuclear/cytoplasmic ratios. The lower and surface bile duct tumours were diagnosed as adenocarcinoma. Thus, the final histological diagnosis was extensive adenoendocrine cell carcinoma of the bile duct. An abdominal CT carried out 3 months postoperatively revealed recurrent multiple liver metastases. The patient died 5 months after the surgery. According to the autopsy results, all of the recurrent metastases were histologically diagnosed as endocrine cell carcinoma, and there were no metastases showing the histological picture of adenocarcinoma.
