A case of diffuse bile duct carcinoma with multiple bile duct stenosis successfully resected by a left hepatic trisegmentectomy, caudate lobectomy, and pancreatoduodenectomy

Abstract

Bile duct carcinoma with multiple stenosis in the biliary system is hardly distinguished from primary sclerosing cholangitis.
A-70-year-old woman was referred to our department because of the dilatation of the biliary tree detected by a CT scan. Cholangiography demonstrated stenoses of the right hepatic duct and common bile duct. Because biopsy specimens were found to be adenocarcinoma, we performed a left hepatic trisegmentectomy with caudate lobectomy and pylorus-preserving pancreatoduodenectomy 4 weeks after percutaneous transhepatic portal embolization (PTPE).
Pathological examination of resected specimen disclosed that moderately differentiated adenocarcinoma was continuously spread from the left hepatic and anterior segmental ducts down to the intrapancraetic bile duct. The carcinoma had various degrees of invasion and desmoplastic reaction from site to site. We speculate that the multiple stenosis in biliary tree of this case is due to the differences in the cancer invasion and the desmoplastic reaction between the stenotic lesions and the others.