Double trouble: synchronous extrahepatic cholangiocarcinoma and gallbladder cancer in a Caucasian woman with no pancreaticobiliary maljunction (original) (raw)
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Cureus, 2021
Synchronous malignancies involving the gallbladder and the bile duct are exceedingly rare. Moreover, their association with anomalous pancreaticobiliary duct junction (APBDJ) has been reported mostly from the Far Eastern countries. Over time, many studies have suggested the definite risk of malignancy attributable to the 'carcinogenic anatomical configuration' of the long common biliopancreatic channel, allowing reflux of pancreatic juices in the biliary tract. In this report, we present a case of an elderly man from South India who was initially diagnosed with synchronous gall bladder with bile duct malignancy; the patient turned out to have an APBDJ on further evaluation.
Metachronous cancer of gallbladder and pancreas with pancreatobiliary maljunction
World Journal of Gastrointestinal Surgery, 2010
Pancreaticobiliary maljunction is a congenital anomaly in which the junction between the pancreatic duct and the common bile duct is located outside the sphincter of Oddi. It is well known that pancreaticobiliary maljunction is frequently associated with carcinoma of the biliary tract. We report a case of metachronous cancer of the gallbladder and pancreas associated with pancreaticobiliary maljunction and cystic dilatation of common bile duct in a 68-year-old Tunisian woman who underwent a cholecystectomy for acute cholecystitis. The pancreatic tumor was an adenosquamous carcinoma. Pancreaticobiliary maljunction allows for pancreatobiliary or biliopancreatic reflux which may induce biliary tract carcinoma. Few cases of multifocal cancer associated with this anomaly have been reported. The association with pancreatic carcinoma remains rare. Close attention should be given to both the biliary tract system and pancreas during the long-term follow-up of patients with pancreaticobiliary maljunction, especially after they have undergone a choledochojejunostomy.
A Case of Gallbladder Cancer Associated with Pancreaticobiliary Maljunction
The Kurume Medical Journal, 2002
We report a case of gallbladder cancer associated with pancreaticobiliary maljunction. The patient was a 60-year-old woman who consulted a local doctor because of discomfort in the right hypochondriac region. Abdominal ultrasonography (US) showed a gallbladder abnormality, and she was referred to Kurume University Hospital, where she was hospitalized for further study and surgery. Abdominal US revealed a sessile tumor with an irregular surface in the fundus of the gallbladder. The internal echo of the tumor was nonhomogeneous, and the structure of the gallbladder wall was partly torn. The common bile duct and the left intrahepatic bile duct were dilated. Abdominal computed tomography (CT) showed an elevated lesion with the same degree of imaging effect as that of the liver on the peritoneal side of the fundus of the gallbladder. The structure of the gallbladder was preserved, and the gallbladder was well demarcated from the surrounding tissue. No hepatic or lymph node metastases were noted. Endoscopic retrograde cholangiopancreatography (ERCP) visualized the pancreaticobiliary maljunction where the pancreatic duct joined the bile duct, entering an approximately 2-cm-long common channel. Dilatation of the common bile duct and intrahepatic bile ducts was observed and diagnosed as the IV-A type according to the Toya classification. Abdominal angiography in the arterial phase showed dilatation of the cystic artery and hyperplasia of vessels but no apparent encasement. In the venous phase, a deep-staining tumor was observed. From the above findings, we made a diagnosis of gallbladder cancer complicating pancreaticobiliary maljunction, and performed an operation. Since intraoperative US showed that the outermost layer of the gallbladder was in part ill-demarcated, we diagnosed the depth of penetration as ss, and performed cholecystectomy and bile duct resection and hepatic resection (S4a and S5), and lymphnode dissection (D2; dissection of groups 1 and 2 lymphnodes). The resected specimen grossly showed a papillomatous lesion with a cauliflower-like surface. The histopathologic diagnosis was papillary adenocarcinoma, depth ss, stage II. Tumor cells proliferated in a papillomatous pattern and were mostly confined to the muscular coat but partly infiltrated into the subserosal coat. In the diagnosis of pancreaticobiliary maljunction, it is crucial to consider complicating gallbladder cancer.
Simultaneous gallbladder and bile duct cancers: revisiting the pathological possibilities
HPB, 2008
The pathogenesis of gallbladder cancer presenting synchronously with malignancy of the bile duct has not been clearly understood. The possible causes for the simultaneous presence of these tumors could be due to local spread, metastases, de novo multifocal origin, or as part of a field change in the extrahepatic biliary apparatus. In this article, we discuss the cases of four patients with simultaneous gallbladder and bile duct malignancies and analyze their individual pathologies to provide an explanation into the mechanisms that may play a role in such conditions.
Mirizzi's syndrome masquerading as cholangiocarcinoma: a case report
Introduction: Mirizzi's syndrome is a rarely observed disorder that presents with obstructive jaundice. The condition is caused by a stone impacted in the gall bladder neck or cystic duct that impinges on the common hepatic duct, with or without a cholecystocholedochal fistula. The condition is often confused with other serious conditions such as hilar cholangiocarcinoma, which present with similar clinical and imaging findings, and a pre-operative diagnosis may be a serious challenge.
Malignant tumours of gallbladder and extrahepatic bile ducts
Diagnostic Histopathology, 2010
Biliary tract neoplasms are divided into cancers of the gallbladder (GB) and intrahepatic and extrahepatic bile ducts (EBD). GB and EBD tumours are closely related, although they show marked differences in epidemiology, aetiology and clinical presentation. GB neoplasms are uncommon in North America but endemic in South America and Asia, whereas EBD tumours show no geographic predilection. Both gallbladder cancer (GBC) and extrahepatic bile duct cancer (EBDC) present at an advanced stage, and are associated with an aggressive course and poor prognosis. These tumours occur primarily in older patients and are strongly associated with chronic inflammation of the biliary epithelium. GBC is more common in women while EBDC is slightly more common in men. Over 90% are carcinomas, usually of the pancreaticobiliary type. Histologic grade, histologic type and stage of disease are useful prognostic indicators. Compared with other histologic variants, papillary carcinomas at both sites have a more favourable prognosis. Despite the common embryologic and histologic features of the bile duct and gallbladder, the natural history and management of cancer arising from these structures have both similarities and major differences.
Japanese journal of clinical oncology, 1989
An 81-year-old woman, diagnosed as having a lower bile duct carcinoma by percutaneous transhepatic cholangiography and cytology of the bile after the onset of repeated nausea and fever around November, 1986, was given a pancreatoduodenectomy in February, 1987. From histological analyses of specimens taken at surgery, papillary adenocarcinoma of the lower bile duct was revealed with a massive amount of mucin in the cancerous gland lumens, the bile duct and the tubular adenocarcinoma retained in the mucosal layers of the gallbladder. Lying between these carcinoma sites was found atypical epithelia of a lesion borderline between benign and malignant (Group III). The patient's postoperative progress was fair, but she died suddenly of cerebral hemorrhage in July, 1988. No intraperitoneal or general carcinoma relapse was found at autopsy. This is one of the relatively rare cases of a simultaneous development of gallbladder and bile duct carcinomas and we found it of great interest tha...
International Medical Case Reports Journal, 2021
Background: Adenomatous hyperplasia (AH) is an uncommon benign lesion of the gallbladder (GB), predominantly seen in men. AH is commonly confused with malignant GB neoplasms in the setting of chronic cholecystitis and gallstones. There is a scarcity of published literature on AH, suggesting its rarity and the need for this case report. Case Presentation: A 24-year-old woman from Western Uganda presented with signs and symptoms consistent with extrahepatic biliary obstruction. Trans-abdominal ultrasound scan revealed cholecystomegaly (13.9 cm by 4.29 cm), thickened GB wall at 5.2 mm, with a poorly defined hypoechoic polypoid solid mass involving the fundal body of the GB. Explorative laparotomy with cholecystectomy and lymph node sampling was performed. Histopathological examination was consistent with adenomatous hyperplasia of the GB. The symptoms and laboratory values improved on follow-up in the clinic after laparotomy. Conclusion: Adenomatous hyperplasia may be misdiagnosed as a malignant GB neoplasm, especially in the setting of chronic cholecystitis and gallstones. If a correct histopathological diagnosis is made, no further diagnostic work-up is necessary following surgical interventions.
Mirizzi Syndrome: Diagnosis and Management of a Challenging Biliary Disease
Canadian Journal of Gastroenterology and Hepatology, 2018
Background. Mirizzi syndrome is a condition difficult to diagnose and treat, representing a particular “challenge” for the biliary surgeon. The disease can mimic cancer of the gallbladder, causing considerable diagnostic difficulties. Furthermore, it increases the risk of intraoperative biliary injury during cholecystectomy. The aim of this study is to point out some particular aspects of diagnosis and treatment of this condition. Methods. The clinical records of patients with Mirizzi syndrome, treated in the last five years, were reviewed. Clinical data, cholangiograms, preoperative diagnosis, operative procedures, and early and late results were examined. Results. Eighteen consecutive patients were treated in the last five years. Presenting symptoms were jaundice, pain, and cholangitis. Preoperative diagnosis of Mirizzi syndrome was achieved in 11 patients, while 6 had a diagnosis of gallbladder cancer and 1 of Klatskin tumor. Seventeen patients underwent surgery, including cholec...