Korean J Gastroenterol.  2013 Jan;61(1):50-53. 10.4166/kjg.2013.61.1.50.

Metastatic Common Bile Duct Cancer from Pulmonary Adenocarcinoma Presenting as Obstructive Jaundice

• Cha IH
• Kim JN
• Kim YS
• Ryu SH
• Moon JS
• Lee HK

• KMID: 1775788
• DOI: http://doi.org/10.4166/kjg.2013.61.1.50

Abstract

We report an extremely rare case of metastatic common bile duct cancer from pulmonary adenocarcinoma presenting as obstructive jaundice. The patient was a 76-year-old male, who presented with generalized weakness and right upper quadrant pain. Plain chest X-ray noted multiple small nodules in both lung fields. Abdominal computed tomography scan showed a stricture of the mid common bile duct along with ductal wall enhancement. Endoscopic retrograde cholangiography revealed a concentric, abrupt narrowing of the mid-common bile duct suggestive of primary bile duct cancer. However, pathology comfirmed metastatic common bile duct cancer arising from pulmonary adenocarcinoma with immunohistochemical study with thyroid transcriptional factor-1 (TTF-1).

Keyword

Common bile duct neoplasms; Neoplasm metastasis; Lung adenocarcinoma; Obstructive jaundice; TTF-1

MeSH Terms

Adenocarcinoma/*diagnosis/pathology/radiography
Aged
Brain Neoplasms/radiography/secondary
Bronchoscopy
Cholangiopancreatography, Endoscopic Retrograde
Common Bile Duct Neoplasms/*diagnosis/secondary
DNA-Binding Proteins/metabolism
Humans
Immunohistochemistry
Jaundice, Obstructive/*etiology
Lung Neoplasms/*diagnosis/pathology/radiography
Male
Positron-Emission Tomography
Tomography, X-Ray Computed
DNA-Binding Proteins

Figure

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  Fig. 1. Plain chest X-ray. Multiple small nodules were found in both lung parenchyma.

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  Fig. 2. Abdominal CT scan. (A) Ductal wall enhancement (arrow) was seen on axial image. (B) Note the stricture at the mid-common bile duct along with shouldering and ductal wall enhancement (arrow) on coronal image.

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  Fig. 3. Imaging and histologic findings of the common bile duct. (A) Endoscopic retrograde cholangiography revealed a concentric, abrupt narrowing of the mid-common bile duct. (B) Biopsy exhibited clusters of malignant columnar cells with prominent nucleoli and intracytoplasmic mucin vacuoles (H&E, ×400). (C) Adenocarcinoma cells demonstrated strong nuclear immunoreactivity for thyroid transcriptional factor-1 (×400).

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  Fig. 4. Bronchoscopic findings and bronchial biopsy specimen. (A) Bronchoscopy showed hyperemic mucosal change, finding suspicious of cancer cell infiltration. (B) Biopsy revealed haphazardly infiltrating nests of adenocarcinoma cells with intracytoplasmic mucin production (H&E,×200). (C) Adenocarcinoma cells were also reactive for thyroid transcriptional factor-1 (×400).

Reference

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