A CASE OF CARCINOMAS OF THE GALLBLADDER, COMMON BILE DUCT AND PANCREAS ASSOCIATED WITH ANOMALOUS ARRANGEMENT OF THE PANCREATICOBILIARY DUCTAL SYSTEM

Abstract

A 58-year-old man was found to have an irregular, elevated lesion in the neck of the gallbladder and a cyst of about 6.5 cm in diameter in the tail of the pancreas by abdominal ultrasonography and CT. Percutaneous transhepatic cholangiography revealed about 2 cm shadow defect at the neck of the gallbladder and a translucent image of 30×12 mm in the intrapancreatic bile duct. A bile test and smear examination revealed both gallbladder bile and the bile duct tumor to be class V. Based on the above findings, the patient underwent surgery under the diagnosis of carcinomas of the gallbladder and common bile duct, and chronic pancreatitis accompanied by pancreatic cyst. Total pancreatetomy and extended cholecystectomy with R2 lymph node dissection were performed because a suspected tumorous lesion was found within the pancreatic cyst by intraoperative ultrasonography. The lesions in the gallbladder and common bile duct were stage I papillary adenocarcinoma with a depth of invasion to ss and stage I papillary adenocarcinoma with a depth of invasion to m. In addition, a papillary adenocarcinoma was localized almost entirely in the main pancreatic duct and its branch, ranging from the head to the tail of the pancreas. The cyst in the pancreatic tail was a pseudocyst. No continuity was noted between the tumors. Furthermore, anomalous arrangement of the pancreaticobiliary ductal system was evidenced by postoperative contrast radiography of surgical specimen.