So-called Carcinosarcoma of the Distal Common Bile Duct Diagnosed by Postoperative Histopathology—A Case Report—

Abstract

We report a rare case of “so-called” carcinosarcoma of the distal bile duct. Carcinosarcoma is described as a malignant tumor with an admixture of both epithelial and mesenchymal components. Carcinosarcoma lesions are most frequently reported in the female genital system, esophagus, lungs, kidneys, bladder and breast. However, distal common bile duct carcinosarcoma is very rare. A 78-year-old man was referred to our hospital due to jaundice. Dynamic CT and ERCP revealed an 18-mm-long circumferential stenosis in the middle portion of the bile duct. Endoscopic retrograde forceps biopsy revealed well to moderately differentiated adenocarcinoma. He was diagnosed as having distal bile duct adenocarcinoma (cT2N1M0c Stage IIB) and treated by subtotal stomach-sparing pancreatoduodenectomy. Postoperative histopathological examination revealed spindle-shaped atypical cells with irregular nuclei infiltrating the bile duct wall, with fibrosis. Immunohistochemistry showed positive staining of the spindle cells for pancytokeratin (AE1/AE3). The final pathological diagnosis was “so-called” carcinosarcoma of the distal common bile duct. The patient remains alive and without recurrence now, 6 months after the surgery (with no adjuvant therapy).