In recent years, it has been noted that congenital biliary dilatation is apt to be associated with cholangiocarcinoma, and the involvement of the abnormal confluence of the pancreas and the bile duct in this carcinogenic mechanism is now being discussed. We have recently experienced gallbladder carcinoma occurring in a case of congenital biliary dilatation accompanied with abnormal pancreas-bile duct confluence. This case is described with some comments based on the literature.
The patient was a 64-year-old woman who visited our hospital because of epigastric dysphoria. The patient was preopeartively diagnosed as having biliary calculus. Perioperative cholangiography, however, revealed congenital biliary dilatation accompanied with abnormal pancreas-bile duct confluence. Therefore, biliary reconstruction composed of extensive cholecystectomy, common bile duct resection in the dilated area and cholangiojejunostomy by the Roux-en-Y method was performed. The amylase level in bile was as high as 21412 SU. Histopathological examination revealed a differentiated adenocarcinoma of the gallbladder and mucous gland metaplasia in non-cancerous areas of the gallbladder.
This case is of interest in that it suggests a relationship between abnormal pancreas-bile duct confluence and the occurrence of carcinoma.