2022 Volume 36 Issue 5 Pages 633-639
The patient was a female in her 80s who had received laparoscopic cholecystectomy due to a gallstone 8 years previously. She had pain from the right precordial region to the back. Dynamic CT of the abdomen showed dilatation of the intra- and extrahepatic bile duct and a tumor of 3.5×2 cm with contrast enhancement that filled the lumens of the dilated remnant cystic duct to the common hepatic duct and intrapancreatic bile duct. MRCP delineated the remnant cystic duct as a defect due to a tumor of 4 cm in diameter showing papillary growth, and the tumor extended into the common bile duct. No extrabiliary infiltration was noted, and subtotal stomach-preserving pancreaticoduodenectomy was performed with a diagnosis of primary papillary tumor of the remnant cystic duct. On gross examination of the excised specimen, the lesion was a papillary tumor of 3.4×2.2 cm having the base in the remnant cystic duct with no mucus in the bile duct. Histopathological examination characterized the lesion as a carcinoma in situ, and a diagnosis of intracholecystic papillary neoplasm with high-grade intraepithelial neoplasia was made. Although no grossly elevated lesion was detected from the common hepatic duct to common bile duct, moderate atypia corresponding to low-grade BilIN was histologically demonstrated.
