A case of early bile duct carcinoma diagnosed by peroral cholangioscopy

Abstract

A 65-year-old man with epigastralgia was diagnosed as having an early bile duct carcinoma. Abdominal CT showed the enhanced mass at middle bile duct closed to cystic duct. EUS showed the heterogeneous internal echoic tumor within common bile duct. Endoscopic retrograde cholangiogram revealed the filling defect within the middle bile duct. Peroral cholangiography revealed pedicellate protruding lesion which was surrounded by whitish granuloplastic nodules. Took a biopsy under the direct observation of the lesion indicated well differentiated adenocarcinoma. Therefore, cholangiojejunostomy and cholecystectomy were performed. Histological examination of the resected specimen showed the tumor to be a moderate differentiated tubular adenocarcinoma with limited invasion of the mucosal layer of the middle bile duct. Neither lymph node metastasis nor perineural invasion were found. Post operative recovery was smooth and he has remained in good condition in the 5 months since, free of signs and symptoms of the recurrence. This report emphasizes the usefulness of the peroral cholangioscopy for diagnostic of the cholangiocarcinoma.