ADENOSQUAMOUS CELL CARCINOMA OF THE BILE DUCT WITH AN EARLY GASTRIC CANCER-A CASE REPORT-

Abstract

Adenosquamous cell carcinoma is a relatively rare tumor in the bile duct. This is to report a case of adenosquamous cell carcinoma of the bile duct with an early gastric cancer. A 67-year-old woman visited a local physician because of epigastric pain. Gastric endoscopy revealed an early gastric cancer, type Ila on the posterior wall of the middle stomach. After that the patient developed jaundice and was referred to the hospital. On admission, remarkable jaundice was noted. An egg-sized swollen gallbladder with tenderness was palpated. Abdominal CT and ultrasonography visualized significantly swollen gallbladder and intrahepatic bile duct, and PTGBD was performed. A papillary tumor was found in the middle portion of the bile duct. The patient was diagnosed as having a carcinoma of the common bile duct and early gastric cancer. Total gestrectomy and pancreaticoduodenectomy were performed. In the excised bile duct specimen, the coexistence of adenocarcinoma of every variety of differentiation and squamous cell carcinoma with keratinization was confirmed. So it was diagnosed as adenosquamous cell carcinoma. Partial bone and cartilatenous metaplasia was also recognized within carcinoma. The gastric lesion was histologically well differentiated adenocarcinoma. Flow cytometric analysis of DNA ploidy of adenosquamous cell carcinoma exhibited diploid pattern. As of 20 months after the operation the patient has hepatic metastasis, but she is still alive by trans-arterial embolization.