Primary Double Cancer Metachronously Occurred in the Biliary System.
- Author:
Chang Joon AHN
1
;
Jae Roung LEE
Author Information
1. Department of Surgery, Taejeon St. Mary's Hospital, The Catholic University of Korea, Taejeon, Korea.
- Publication Type:Case Report
- Keywords:
Primary double cancer;
Metachronous onset;
Gall bladder;
Common bile duct
- MeSH:
Adenocarcinoma;
Animals;
Biliary Tract*;
Cats;
Cholangiopancreatography, Endoscopic Retrograde;
Cholecystectomy;
Common Bile Duct;
Cystic Duct;
Daejeon;
Duodenum;
Follow-Up Studies;
Humans;
Internal Medicine;
Jaundice;
Liver;
Lymph Nodes;
Male;
Middle Aged;
Neck;
Outpatients;
Pancreaticoduodenectomy;
Pruritus;
Sensation;
Ultrasonography;
Urinary Bladder
- From:Journal of the Korean Surgical Society
1997;52(2):299-304
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
We have surgically experienced a case with primary double cancer which metachronously occurred in the gall bladder and the distal portion of common bile duct. This 61-year-old male underwent cholecystectomy with en bloc wedge resection of liver due to the malignant tumor in the gall bladder about 30 months ago. The histopathological examination revealed that the lesion was adenocarcinoma, moderately to poorly differentiated, with partly neuroendocrine differentiation, in the neck portion of the gall bladder (Figure 1). The malignant potential invaded to the subserosal layer, and the resected margin of the cystic duct was free from the malignant invasion. During the post-operative period, he has periodically or sporadically visited the out-patient Department of Surgery and Internal Medicine at Taejeon St. Mary's Hospital for follow-up studies. He was admitted again because of the insiduous onset of painless jaundice along with generalized itching sensations. The studies, using the ultrasonogram and the CAT scan, showed that the intra- and extra-hepatic biliary trees were moderately dilated due to a mass effect at the distal portion of the common bile duct (Figure 2). The ERCP revealed the lesion was malignant(Figure 3), and histologically confirmed adenocarcinima, well differentiated. He underwent Whipple's pancreaticoduodenectomy with regional lymph node dissection(Figure 4). The histopathological examination revealed that the lesion was adenocarcinoma, moderately differentiated, with lymphatic and perineural invasion, in the distal portion of the common bile duct (Figure 5). The malignancy extended toward the submucosal layer of duodenum and the pancreatic parenchyme. The resected margin of common bile duct was free from malignant invasion. He recovered uneventfully from the second surgical intervention. He periodically visits the out-patient Department of Surgery nowadays.
