Abstract
A 66-year-old man had underwent distal gastrectomy with D2 lymph node dissection and reconstructed by Billroth I method for gastric cancer in 2009. The histopathological diagnosis was por2>sig, T3, ly2, v0, N0, M0, fStage II, and R0. Thereafter he had been free from recurrence until June 2016 when a contrast-enhanced CT scan showed dilatation of the left intrahepatic bile duct, soft tissue shadow at the left intrahepatic bile duct, and disruption of the left branch of the portal vein. Bile duct carcinoma arisen from the left hepatic duct and involvement of the left branch of portal vein were suspected. We performed extended left and caudal lobectomy, associated resection and reconstruction of the portal vein, and resection of the extrahepatic bile duct. The histopathological diagnosis was moderately differentiated tubular adenocarcinoma ; the fibrous muscle layer in the hilar bile duct region had hypertrophied, at where proliferation of atypical cells involving those showing signet ring cell like morphology was confirmed. Immunostaining of the tumor cells showed CK7(+) and CK20(+) that was the same pattern as the previous gastric cancer. Accordingly bile duct metastasis of gastric cancer was diagnosed.
Bile duct metastasis of gastric cancer rarely occurs. This paper deals with a case of metastasis of gastric cancer to the bile duct which occurred more than 7 years after curative operation and presented great difficulties in diagnosis.
