A case of cystic duct carcinoma diagnosed after treatment for acute cholangitis

Abstract

An 80-year-old man was admitted to our hospital due to general fatigue. Laboratory examinations revealed liver dysfunction and inflammation. Ultrasonography revealed choledocholithiasis and dilated bile duct. Acute cholangitis was diagnosed and treated with antibacterial agents. Dynamic CT revealed a lesion with contrast effect in the cystic duct wall. We suspected cystic duct carcinoma. Endoscopic removal of bile duct stone was performed, and bile cytology revealed no atypical cells. Follow-up CTs were performed to rule out inflammatory changes. After five months, CT scan revealed worsening of the cystic duct thickness. However, malignant cells were not identified on newly performed bile cytology. However, the clinical course strongly suggested cystic duct carcinoma. Therefore, an extrahepatic bile duct resection was performed. The nodular lesion of the cystic duct was a well-differentiated adenocarcinoma that expanded to the common bile duct epithelium. In this study, cystic duct carcinoma was suspected before surgery due to its tendency to grow larger.