Yoo Youngsun, Mun Seongpyo
Department of Surgery, Chosun University, School of Medicine, 365 Pilmun-daero, Dong-gu, Gwangju, 501-717, South Korea.
J Med Case Rep. 2015 May 19;9:116. doi: 10.1186/s13256-015-0600-1.
Synchronous double cancers of the bile duct are exceptionally rare. We here report a case of synchronous squamous cell carcinoma and adenocarcinoma of the extrahepatic bile duct.
A 67-year-old Asian man visited our clinic complaining of jaundice and dark urine. Direct hyperbilirubinemia and an elevated cancer antigen 19-9 level were detected. Preoperative abdominal computed tomography and positron emission tomography showed two masses at the bifurcation of the common hepatic duct and at the distal common bile duct. After biliary drainage, we performed radical pylorus-preserving pancreaticoduodenectomy, without resection margin involvement. Pathological findings revealed that the proximal lesion was a squamous cell carcinoma and that the distal lesion was an adenocarcinoma. Both cholangiocarcinomas were confined to the fibromuscular layer, and there was no communication between the two tumors. Multiple conglomerated metastatic tumors were detected in his liver 3 months after surgery. He died 8 months after diagnosis.
The disease displayed very aggressive behavior and a very poor prognosis. The only chance for long-term survival is treatment with radical resection. Preoperative positron emission tomography-computed tomography is useful in detecting occult cancer.
胆管同步性双癌极为罕见。我们在此报告一例肝外胆管同步性鳞状细胞癌和腺癌病例。
一名67岁的亚洲男性因黄疸和深色尿前来我院就诊。检测到直接胆红素血症和癌抗原19-9水平升高。术前腹部计算机断层扫描和正电子发射断层扫描显示在肝总管分叉处和胆总管远端有两个肿块。在进行胆道引流后，我们实施了保留幽门的根治性胰十二指肠切除术，切缘无肿瘤累及。病理结果显示近端病变为鳞状细胞癌，远端病变为腺癌。两种胆管癌均局限于纤维肌层，且两个肿瘤之间无连通。术后3个月在其肝脏中检测到多个融合性转移瘤。他在诊断后8个月死亡。
该疾病表现出极具侵袭性的行为和极差的预后。长期生存的唯一机会是进行根治性切除治疗。术前正电子发射断层扫描-计算机断层扫描有助于检测隐匿性癌症。
