[An autopsy case of adenosquamous cell carcinoma of the extrahepatic bile duct with endobronchial mass obstructing the left main bronchus and masquerading as asthma].

A 65-year-old male was admitted with diagnosis of bronchial asthma. On admission, he was orthopneic, cyanotic and distressed. Marked hypoxemia with PaO2 of 31.1 mmHg was noted, but no obvious localized airway obstruction on plain chest X-ray film could be detected. These was minimal response to intensive treatment with steroid in addition to various bronchodilators on the presumed diagnosis of bronchial asthma. Two weeks later, chest X-ray disclosed complete atelectasis of the left lung. Stenosis of the left main bronchus with enlarged mediastinal lymph nodes on chest CT was suggested. Endoscopic examination disclosed complete obstruction of the left main bronchus just beyond the carina and polypoid tumors in the right main bronchus and basal segment bronchus. The biopsy specimens revealed squamous cell carcinoma. Chemotherapy with CDDP and VDS resulted in disappearance of atelectasis after one week and marked relief of respiratory distress. Four months later, at the completion of irradiation therapy, an abdominal tumor associated with pain appeared and bone scintigram showed multiple bone metastases. After four times chemotherapy including CDDP, hypercalcemia and renal hypofunction developed, and the patient died. Autopsy disclosed a tumor in the extrahepatic bile duct, cystic lesions of the pancreas and swelling of subcarinal lymph nodes, but no tumorous lesion in the lung and endobronchial tissue. Histological examination of the extrahepatic bile duct tumor revealed adenosquamous cell carcinoma, with predominantly squamous cell carcinoma. Other metastatic lesions consisted of squamous cell carcinoma. These findings are compatible with pulmonary metastases of adenosquamous cell carcinoma of the extrahepatic bile duct.