Abstract
BackgroundTumor thrombus in the portal vein is a common complication of hepatocellular carcinoma, but an extremely rare complication of common bile duct cancer.Case presentationA 78-year-old woman was referred to our department because of jaundice. Laboratory data showed severe liver dysfunction with high serum levels of total bilirubin and CA19-9. Computed tomography showed lesions in the middle bile duct and main portal vein. FDG PET scan and 3D imaging showed hot spots in the same location as those revealed by CT. Under a diagnosis of middle bile duct cancer with portal vein tumor thrombus, the patient underwent surgery. At laparotomy, the main tumor was found to be located in the middle bile duct with a tumor thrombus, 2 cm in diameter, in the main portal vein. The patient underwent pancreatoduodenectomy with thrombectomy. Histological examination showed that this thrombus had the same histological features as those of the main bile duct cancer (poorly differentiated adenocarcinoma). The postoperative course was uneventful and the patient is doing well without any signs of recurrence 18 months after surgery.ConclusionTo our knowledge, this is the first report of successful resection of middle bile duct cancer with portal vein tumor thrombus.
Highlights
Tumor thrombus in the portal vein is a common complication of hepatocellular carcinoma, but an extremely rare complication of common bile duct cancer.Case presentation: A 78-year-old woman was referred to our department because of jaundice
The bile duct is adjacent to the portal vein anatomically, Bile duct cancer (BDC) is rarely complicated by tumor thrombus in the main portal vein (PV)
We present the first reported case of successfully resected middle BDC complicated by Portal vein tumor thrombus (PVTT)
Summary
Bile duct cancer (BDC), classified as cancer of the middle or distal bile duct, was the 6th leading cause of cancerrelated death in Japan in 2004 [1]. The bile duct is adjacent to the portal vein anatomically, BDC is rarely complicated by tumor thrombus in the main portal vein (PV). We present the first reported case of successfully resected middle BDC complicated by PVTT. Computed tomography (CT) showed a mass in the middle bile duct and main PV (Figure 1a and 1b). After reduction of serum total bilirubin, under a diagnosis of middle BDC with PVTT, the patient underwent surgery. The main tumor was located in the middle bile duct, and a tumor thrombus 2 cm in diameter was present in the main PV. Histological examination showed that bile duct cancer was a poorly differentiated adenocarcinoma, T4, N2, M0 and stage IV, according to the AJCC classification [4], and the thrombus showed the same histological features as those of the main tumor (Figure 5a,b). She is doing well without any signs of recurrence 18 months after surgery
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