Cargando…

A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy

BACKGROUND: In situ cholangiocarcinoma is difficult to detect by imaging studies. Thus, cholangiocarcinoma is rarely resected with a preoperative definitive diagnosis, especially nonpapillary flat type in situ carcinoma, which is extremely rare. CASE PRESENTATION: A 70-year old man was diagnosed wit...

Descripción completa

Detalles Bibliográficos
Autores principales: Maeda, Takashi, Ebata, Tomoki, Yokoyama, Yukihiro, Igami, Tsuyoshi, Mizuno, Takashi, Yamaguchi, Junpei, Onoe, Shunsuke, Watanabe, Nobuyuki, Nagino, Masato
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842380/
https://www.ncbi.nlm.nih.gov/pubmed/31707480
http://dx.doi.org/10.1186/s40792-019-0745-z
_version_ 1783468039076839424
author Maeda, Takashi
Ebata, Tomoki
Yokoyama, Yukihiro
Igami, Tsuyoshi
Mizuno, Takashi
Yamaguchi, Junpei
Onoe, Shunsuke
Watanabe, Nobuyuki
Nagino, Masato
author_facet Maeda, Takashi
Ebata, Tomoki
Yokoyama, Yukihiro
Igami, Tsuyoshi
Mizuno, Takashi
Yamaguchi, Junpei
Onoe, Shunsuke
Watanabe, Nobuyuki
Nagino, Masato
author_sort Maeda, Takashi
collection PubMed
description BACKGROUND: In situ cholangiocarcinoma is difficult to detect by imaging studies. Thus, cholangiocarcinoma is rarely resected with a preoperative definitive diagnosis, especially nonpapillary flat type in situ carcinoma, which is extremely rare. CASE PRESENTATION: A 70-year old man was diagnosed with gallbladder cancer and received open cholecystectomy with lymphadenectomy at a local hospital. Histologically, the tumor was localized in the mucosal layer, and no lymph node metastases were found. Three months later, hilar bile duct stricture due to delayed bile duct ischemia was found. Then, biliary drainage was performed with endoscopic biliary stenting. Three months later, the patient experienced cholangitis with septic shock, and percutaneous transhepatic biliary drainage (PTBD) into the left intrahepatic bile duct was performed. Unexpectedly, the aspiration bile cytology of the PTBD catheter showed malignant cells, and the patient was referred to our clinic for possible surgical treatment. According to additional studies, the hilar bile duct stricture was 3 cm in length. None of the imaging studies detected malignant cells in the bile duct around the hilar stricture. The left portal vein was obstructed due to inadvertent puncture of the PTBD. No findings indicated cholangiocarcinoma. We performed left hepatectomy with caudate lobectomy and extrahepatic bile duct resection. The postoperative course was uneventful. In the final pathology, flat type in situ carcinoma was found at the confluence of the right and left hepatic ducts, which was distant from the biliary stricture. CONCLUSIONS: When a tumor is undetectable but cytology is positive, in situ cholangiocarcinoma may exist; thus, surgery should be carefully considered.
format Online
Article
Text
id pubmed-6842380
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-68423802019-11-22 A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy Maeda, Takashi Ebata, Tomoki Yokoyama, Yukihiro Igami, Tsuyoshi Mizuno, Takashi Yamaguchi, Junpei Onoe, Shunsuke Watanabe, Nobuyuki Nagino, Masato Surg Case Rep Case Report BACKGROUND: In situ cholangiocarcinoma is difficult to detect by imaging studies. Thus, cholangiocarcinoma is rarely resected with a preoperative definitive diagnosis, especially nonpapillary flat type in situ carcinoma, which is extremely rare. CASE PRESENTATION: A 70-year old man was diagnosed with gallbladder cancer and received open cholecystectomy with lymphadenectomy at a local hospital. Histologically, the tumor was localized in the mucosal layer, and no lymph node metastases were found. Three months later, hilar bile duct stricture due to delayed bile duct ischemia was found. Then, biliary drainage was performed with endoscopic biliary stenting. Three months later, the patient experienced cholangitis with septic shock, and percutaneous transhepatic biliary drainage (PTBD) into the left intrahepatic bile duct was performed. Unexpectedly, the aspiration bile cytology of the PTBD catheter showed malignant cells, and the patient was referred to our clinic for possible surgical treatment. According to additional studies, the hilar bile duct stricture was 3 cm in length. None of the imaging studies detected malignant cells in the bile duct around the hilar stricture. The left portal vein was obstructed due to inadvertent puncture of the PTBD. No findings indicated cholangiocarcinoma. We performed left hepatectomy with caudate lobectomy and extrahepatic bile duct resection. The postoperative course was uneventful. In the final pathology, flat type in situ carcinoma was found at the confluence of the right and left hepatic ducts, which was distant from the biliary stricture. CONCLUSIONS: When a tumor is undetectable but cytology is positive, in situ cholangiocarcinoma may exist; thus, surgery should be carefully considered. Springer Berlin Heidelberg 2019-11-09 /pmc/articles/PMC6842380/ /pubmed/31707480 http://dx.doi.org/10.1186/s40792-019-0745-z Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Case Report
Maeda, Takashi
Ebata, Tomoki
Yokoyama, Yukihiro
Igami, Tsuyoshi
Mizuno, Takashi
Yamaguchi, Junpei
Onoe, Shunsuke
Watanabe, Nobuyuki
Nagino, Masato
A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy
title A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy
title_full A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy
title_fullStr A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy
title_full_unstemmed A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy
title_short A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy
title_sort case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842380/
https://www.ncbi.nlm.nih.gov/pubmed/31707480
http://dx.doi.org/10.1186/s40792-019-0745-z
work_keys_str_mv AT maedatakashi acaseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT ebatatomoki acaseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT yokoyamayukihiro acaseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT igamitsuyoshi acaseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT mizunotakashi acaseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT yamaguchijunpei acaseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT onoeshunsuke acaseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT watanabenobuyuki acaseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT naginomasato acaseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT maedatakashi caseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT ebatatomoki caseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT yokoyamayukihiro caseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT igamitsuyoshi caseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT mizunotakashi caseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT yamaguchijunpei caseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT onoeshunsuke caseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT watanabenobuyuki caseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy
AT naginomasato caseofsmallinsituperihilarcholangiocarcinomaincidentallyaccompaniedbybenignbileductstrictureafteropencholecystectomy