Biliary Carcinoma Found in First Surgery for Congenital Biliary Dilatation

Abstract

Congenital biliary dilation with pancreaticobiliary maljunction is the origin of biliary tract cancer. Biliary cancer generally has a poor prognosis, so early detection and treatments are required. Biliary cancer that occurs after choledochal cyst surgery is also said to have a poor prognosis. We report the case of a 14-year-old boy who underwent surgical treatment for congenital biliary dilated disease, and bile duct cancer was found in his excised bile duct by histopathological diagnosis. After surgery, chemotherapy was performed on him with gemcitabine + tegafur, gimeracil, and oteracil potassium. Eleven months after surgery, the levels of tumor markers increased, and PET-CT showed recurrence in the pancreatic uncinate process. Therefore, subtotal stomach-preserving pancreaticoduodenectomy was performed at another hospital. After surgery, chemotherapy with tegafur, gimeracil, and oteracil potassium was continued. Four years after the first operation, a CT scan showed recurrence in the lymph node. Thus, he continued chemotherapy with gemcitabine + cisplatin. In addition, we reexamined the pathological features of pancreatic tumors that seemed to show the metastatic recurrence of bile duct cancer on the basis of the initial histopathological findings. As a result, it was decided that there was a possibility of double cancer. Although there was no change in the treatment content and policy, careful follow-up was considered necessary in the future.