2016 Volume 30 Issue 4 Pages 741-748
A 75-year-old woman was referred to our clinic for evaluation of obstructive jaundice. A CT scan revealed stenosis of the distal bile duct at the near portion of the papilla of Vater, with thickness and enhancement at this site. In addition, gallbladder contained 3 elevated lesions. Cytology of the bile obtained from PTBD was positive for malignancy. Under the diagnosis of the carcinoma at the distal bile duct and gallbladder, surgery was performed. The intraoperative evaluation of the common hepatic duct margin, just below the confluence of the left and right hepatic ducts, demonstrated epithelial dysplasia. Based on this finding, a subtotal stomach-preserving pancreaticoduodenectomy was performed without further excision of the bile duct. The postoperative pathology showed invasive cholangiocarcinoma at the distal bile duct with biliary intraepithelial neoplasia (BilIN) extending from the papilla of Vater to the intrahepatic bile duct of the liver bed and gallbladder. The patient survived for 22 months with chemotherapy. We hypothesized that this particular case of invasive cholangiocarcinoma arose from the pre-existing BilIN in the distal common bile duct.
