Coletta Martina, Montalti Roberto, Pistelli Mirco, Vincenzi Paolo, Mocchegiani Federico, Vivarelli Marco
Department of Gastroenterology and Transplantation, Hepatobiliary and Abdominal Transplantation Surgery, Marche Polytechnic University, AOU Ospedali Riuniti, via Conca 71, 60129 Ancona, Italy.
World J Surg Oncol. 2014 Dec 16;12:384. doi: 10.1186/1477-7819-12-384.
BACKGROUND/AIMS: Breast cancer is the most common tumor in women and the first cause of death for malignancy in the female population. Bile ducts are not among the common sites of metastasis from breast cancer; few cases of obstructive jaundice due to metastatic breast cancer have been described in the literature and they mostly resulted from widespread liver metastases that eventually involved the bile ducts. We report an exceptional case of metastatic infiltration of the extrahepatic bile ducts in absence of liver metastases.
A 56-year-old woman who had undergone a right mastectomy 13 years earlier due to infiltrating ductal breast cancer and had remained tumor free, presented at a follow-up examination with obstructive jaundice.Imaging (computed tomography, magnetic resonance and endoscopic retrograde cholangiopancreatography) scans showed features that were suggestive of a primary tumor of the extrahepatic bile duct. At surgery, the intraoperative findings were also those of a tumor of the bile duct, however, an histological examination showed no evidence of malignancy in the mucosa, but did shown an infiltration of the external wall from adenocarcinoma. Immunohistochemistry analysis demonstrated that the tumor was metastatic breast cancer.
Indeterminate stenosis of the extrahepatic bile ducts should be examined with suspicion in women with a history of breast cancer, and bile duct metastases are to be considered among the possible diagnoses. A differential diagnosis from cholangiocarcinoma is of paramount importance and mainly relies on pathology.
背景/目的：乳腺癌是女性最常见的肿瘤，也是女性恶性肿瘤死亡的首要原因。胆管并非乳腺癌常见的转移部位；文献中仅有少数转移性乳腺癌导致梗阻性黄疸的病例报道，且大多是由于广泛的肝转移最终累及胆管所致。我们报告一例无肝转移的肝外胆管转移性浸润的特殊病例。
一名56岁女性，13年前因浸润性导管癌接受了右乳切除术，术后一直无瘤生存，此次随访检查时出现梗阻性黄疸。影像学检查（计算机断层扫描、磁共振成像和内镜逆行胰胆管造影）显示的特征提示肝外胆管原发性肿瘤。手术中，术中所见也是胆管肿瘤，但组织学检查显示黏膜无恶性证据，但显示腺癌浸润外壁。免疫组织化学分析表明该肿瘤为转移性乳腺癌。
有乳腺癌病史的女性，若出现肝外胆管不明原因狭窄，应怀疑有胆管转移，并将其列入可能的诊断之中。与胆管癌进行鉴别诊断至关重要，主要依靠病理学检查。
