J Korean Surg Soc.  2011 Oct;81(4):281-286. 10.4174/jkss.2011.81.4.281.

Synchronous double primary cancers associated with a choledochal cyst and anomalous pancreaticobiliary ductal union

• Choi KK
• Choi SB
• Park SW
• Kim HK
• Park YN
• Kim KS

• KMID: 1445750
• DOI: http://doi.org/10.4174/jkss.2011.81.4.281

Abstract

A 60-year-old female was admitted with epigastric pain lasting a month. Preoperative diagnosis was choledochal cyst with anomalous pancreaticobiliaryductal union (APBDU), C-P type. A papillary mass measuring 2.5 x 1.9 cm was found adjacent to the pancreaticocholedochal junction. Gallbladder (GB) cancer was also observed. Pyloric-preserving pancreaticoduodenectomy (PPPD) was performed. The patient received adjuvant chemotherapy/radiation therapy on the tumor bed. The gallbladder cancer showed serosal invasion, while the bile duct cancer extended into the pancreas. Although common bile duct (CBD) cancer lesion showed focally positive for p53 and the gallbladder cancer lesion showed negative for p53, the Ki-67 labeling index of the CBD cancer and GB cancer were about 10% and 30%, respectively. Nine months after curative resection, a stricture on the subhepatic colon developed due to adjuvant radiation therapy. Localized peritoneal seedings were incidentally found during a right hemicolectomy. The patient underwent chemotherapy and had no evidence of tumor recurrence for two years after PPPD.

Keyword

Choledochal cyst; Gallbladder neoplsms; Bile duct neoplasms; Synchronous multiple primary neoplasms

MeSH Terms

Bile Duct Neoplasms
Choledochal Cyst
Colon
Common Bile Duct
Constriction, Pathologic
Female
Gallbladder
Gallbladder Neoplasms
Humans
Middle Aged
Neoplasms, Multiple Primary
Pancreas
Pancreaticoduodenectomy
Recurrence
Seeds

Figure

• 

  Fig. 1 Magnetic resonance cholangiopancreatography (MRCP) image including vertical and horizontal sections. MRCP shows fusiform cystic changes involving the entire common bile duct and hilar bile duct compatible with a choledochal cyst (type Ia) associated with the long common channel of the pancreaticobiliary junction (C-P type). Irregular wall thickening at the fundus and body of the gallbladder was seen. A 2.5 × 1.9 cm mass is also seen around the pancreaticobiliary junction.

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  Fig. 2 Specimens from patient before and after fixation. The common bile duct (CBD) is markedly dilated, measuring 7 cm in inner circumference and 6.5 cm in length. Opening along the CBD revealed an ill-defined mass measuring 2 × 1.5 cm. The gallbladder shows an ill-defined thickened wall area in the fundus measuring 3 × 3 cm. GB, gallbladder.

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  Fig. 3 Hematoxylin & Eosin stain image of tumor. Tumor shows polypoid growth into the common bile duct (CBD) lumen with pancreatic invasion. (H&E; A, ×40; B, ×100). Adenocarcinoma of the gallbladder invaded fibromuscular connective tissue (H&E; C, ×40; D, ×100).

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  Fig. 4 Immunostaining of tumor. p53 and Ki-67 immunostaining (×100; A, B, common bile duct cancer; C, D, gallbladder cancer) and K-ras mutation analysis (E).

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  Fig. 5 Images of computed tomography (CT), positron emission tomography (PET), colonoscopy and gross specimen for a complication caused by adjuvant radiation therapy. A stricture is shown on the subhepatic colon. (A, CT; B, PET; C, colonoscopy; D, gross specimen).

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