2015 Volume 29 Issue 2 Pages 261-265
We reported a case of early cystic duct cancer with widely spreading carcinoma in situ in the gallbladder. A 78 year-old woman complained of epigastric pain. Abdominal contrast CT showed cystic duct tumors as well as small protruding lesions inside the gallbladder. ERC showed a filling defect shaped like a crab claw in the cystic duct, but did not reveal abnormal findings in the common bile duct. Intraductal ultrasonography showed a hypoechoic tumor inside the cystic duct, which extended into the common bile duct. Based on these findings, papillary cystic duct cancer was diagnosed, and extended cholecystectomy, bile duct resection, and lymph node dissection were performed. The resected specimen contained a 3.5×2.5 cm sized tumor protruding into the cystic duct. The cystic duct was filled with the papillary tumor and some elevated lesions were observed in the mucosa of the gallbladder. Pathological findigs were papillary adenocarcinoma of cystic duct with intramucosal cancer which spread widely in the gallbladder. Intramucosal cancer had spread widely in the gallbladder, but was not continuous, suggesting a multicentric form of carcinogenesis. The patient remains recurrence-free two years after surgery.
