Kraus Ivan, Rubinić Milivoj, Uravić Miljenko, Kovac Drazen, Brncić Nada, Kraus Denis, Vojniković Bozidar
Department of Internal Medicine, University Hospital Center Rijeka, Rijeka, Croatia.
Coll Antropol. 2003 Dec;27(2):677-83.
We report a case of 35-yr-old woman with early cancer in congenital choledochal cyst. She had a five-year history of intermittent right upper abdominal pain and intermittent jaundice. In this period she had a few abdominal ultrasonographies, but the cholelithiasis had not been found. Now, she was admitted to our hospital because she felt right upper abdominal pain with slight jaundice and subfebrile temperature four weeks ago. Abdominal ultrasonography showed enormous dilatation of the common bile duct, which was suspected as choledochal cyst. Computed tomography and endoscopic retrograde cholangiopancreatography revealed cystic dilatation of extrahepatic bile duct. An anomalous pancreaticobiliary junction was not found. The patient with congenital choledochal cyst was operated on. The excision of choledochal cyst was done with hepaticojejunostomy Roux-en-Y. There were no lymph nodes metastases. On the central part of choledochal cysts mucosa, it was shown a white plain area of thickness 0.3 cm and 0.8 cm in diameter. Histologically it was well-differentiated tubular adenocarcinoma, which was limited to the mucosa and which did not penetrate to other parts of the bile duct wall. From our knowledge, only small number cases of early cholangiocarcinoma in choledochal cyst were until now reported. Nearly eight years after the operation the patient feels very well, and has optimal working ability (Karnofsky 100%).
我们报告一例35岁患有先天性胆总管囊肿早期癌症的女性病例。她有五年间歇性右上腹疼痛和间歇性黄疸病史。在此期间，她做过几次腹部超声检查，但未发现胆结石。现在，她因四周前感到右上腹疼痛、伴有轻微黄疸和低热而入住我院。腹部超声检查显示胆总管巨大扩张，怀疑为胆总管囊肿。计算机断层扫描和内镜逆行胰胆管造影显示肝外胆管囊性扩张。未发现胰胆管异常汇合。该先天性胆总管囊肿患者接受了手术。行胆总管囊肿切除并肝空肠 Roux-en-Y吻合术。无淋巴结转移。在胆总管囊肿黏膜中央部分，可见一个白色平坦区域，厚0.3 cm，直径0.8 cm。组织学检查为高分化管状腺癌，局限于黏膜，未穿透至胆管壁其他部位。据我们所知，目前仅有少数先天性胆总管囊肿早期胆管癌病例的报道。术后近八年，患者感觉良好，工作能力最佳（卡诺夫斯基评分100%）。
