Abstract
A 44-yearold man was admitted to our hospital with right back pain and fever. Endoscopic retrograde cholangiographic pancreatography (FRCP) revealed fusiform dilatation of the extrahepatic bile duct with an anomalous junction, the pancreatic duct joining the choledochus. Cholecystectomy, resection of bile duct and hepaticojejunostomy were performed. Pathological examination showed papillotubullar adenocarcinoma of the gallbladder.
The second patient was a 47-year-old woman, who complained of right upper quadrant pain and fever. Abdominal echography showed a tumor of the gallbladder protruding into the lumen. ERCP revealed diffuse dilatation of the extrahepatic and intrahepatic bile ducts with an anomalous junction, the pancreatic duct joining the choledochus. The gallbladder was not visualized. Gallbladder carcinoma was suspected. Cholecystectomy, resection of bile duct with regional lymph nodes and hepaticojejunostomy were performed. The operative diagnosis was Stage I carcinoma. The pathologic diagnosis was papillotubullar adenocarcinoma.
Reviewing the Japanese literatures, an anomalous junction of the pancreaticobiliary ductal system was frequently found in cases of congenital biliary dilatation with gallbladder carcinoma. This fact suggests that this anomaly may be one of the oncogenic factors for this type of malignancy.
