Korean J Hepatobiliary Pancreat Surg.  2015 Aug;19(3):125-128. 10.14701/kjhbps.2015.19.3.125.

Metastatic mucinous adenocarcinoma of the distal common bile duct, from transverse colon cancer presenting as obstructive jaundice

• Lee DH
• Ahn YJ
• Shin R
• Lee HW

• KMID: 2043289
• DOI: http://doi.org/10.14701/kjhbps.2015.19.3.125

Abstract

The patient was a 70-year-old male whose chief complaints were obstructive jaundice and weight loss. Abdominal imaging studies showed a 2.5 cm sized mass at the distal common bile duct, which was suggestive of bile duct cancer. Eccentric enhancing wall thickening in the transverse colon was also shown, suggesting concomitant colon cancer. A colonoscopy revealed a lumen-encircling ulcerofungating mass in the transverse colon, that was pathologically proven to be adenocarcinoma. The bile duct pathology was also adenocarcinoma. Pylorus-preserving pancreaticoduodenectomy and extended right hemicolectomy were performed under the diagnosis of double primary cancers. Postoperative histopathologic examination revealed moderately differentiated mucinous adenocarcinoma of transverse colon cancer, and mucinous adenocarcinoma of the distal common bile duct. Immunohistochemical staining studies showed that the bile duct cancer had metastasized from the colon cancer. The patient recovered uneventfully from surgery and will be undergoing chemotherapy for three months.

Keyword

Mucinous adenocarcinoma; Common bile duct neoplasms; Colon neoplasms; Metastasis; Obstructive jaundice

MeSH Terms

Adenocarcinoma
Adenocarcinoma, Mucinous*
Aged
Bile Duct Neoplasms
Bile Ducts
Colon, Transverse*
Colonic Neoplasms
Colonoscopy
Common Bile Duct Neoplasms
Common Bile Duct*
Diagnosis
Drug Therapy
Humans
Jaundice, Obstructive*
Male
Mucins*
Neoplasm Metastasis
Pancreaticoduodenectomy
Pathology
Weight Loss
Mucins

Figure

• 

  Fig. 1 Preoperative imaging study: A biliary magnetic resonance imaging shows a 2.5 cm mass (arrow) in the distal common bile duct on axial image, suggestive of bile duct cancer.

• 

  Fig. 2 Preoperative imaging study: (A) An abdominal computed tomography scan showed eccentric enhancing wall thickening (arrow) in the proximal transverse colon; (B) A colonoscopy revealed a lumen-encircling ulcerofungating mass in the proximal transverse colon that was pathologically proven to be adenocarcinoma.

• 

  Fig. 3 Photographs of the gross specimen: (A) A 1×1 cm-sized round ulcerative mass (arrow) is shown at the distal common bile duct; (B) Another 3×4 cm-sized ulcerofungating mass (arrow) is identified at the proximal transverse colon.

• 

  Fig. 4 Histologic findings of the common bile duct: Immunohistochemical staining showed a cytokeratin 7 (-) and cytokeratin 20 (+) staining pattern, which is a characteristic of biliary metastasis from colorectal cancer. (A) A photomicrograph shows intraductal metastatic mucin-filled lesion invades the extraductal space of the posterior distal bile duct (H&E, ×12.5). (B and C) Photomicrographs, obtained after immunohistochemical staining with anti-cytokeratin 7 and anti-cytokeratin 20 antibodies, showing that tumor cells were negative for cytokeratin 7 and positive for cytokeratin 20.

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