A case of bile duct cancer with unusual gastric lesion

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A 54-year-old man was admitted with complains of epigastralgia and body weight loss. Endoscopic and barium meal studies showed an elevated lesion such as a submucosal tumor located at the posterior wall of the angulus and the antrum. The lesion was diagnosed as having poorly differentiated adenocarcinoma by the biopsied specimen. Abdominal CT showed an elevated lesion of the stomach, the irregularity of duodenal wall, lymphnode swelling and no metastasis to the liver and the lung. ERCP indicated the stenosis of distal bile duct, and adenocarcinoma cells were detected in bile juice and biopsied specimen of distal bile duct. This case was diagnosed having distal bile duct cancer, and metallic stent was inserted to the portion of stenosis. Although the patient was treated with gemcitabine, the therapy was discontinued because of thrombocytopenia. The patient died on the 47th hospital day because of peritonitis caused by gastric perforation. Autopsy findings revealed that poorly differentiated adenocarcinoma cells infiltrated into the submucosal layer of distal bile duct with lymph duct invasion and multiple lymphnode metastesis. No metastasis was found in the liver and the lung. We reported a interesting case of bile duct cancer with unusual gastric lesion.