Primary Double Cancer Metachronously Occurred in the Biliary System

Ahn, Chang Joon; Lee, Jae Roung

Abstract

We have surgically experienced a case with primary double cancer which metachronously occurred in the gall bladder and the distal portion of common bile duct. This 61-year-old male underwent cholecystectomy with en bloc wedge resection of liver due to the malignant tumor in the gall bladder about 30 months ago. The histopathological examination revealed that the lesion was adenocarcinoma, moderately to poorly differentiated, with partly neuroendocrine differentiation, in the neck portion of the gall bladder (Figure 1). The malignant potential invaded to the subserosal layer, and the resected margin of the cystic duct was free from the malignant invasion. During the post-operative period, he has periodically or sporadically visited the out-patient Department of Surgery and Internal Medicine at Taejeon St. Mary's Hospital for follow-up studies. He was admitted again because of the insiduous onset of painless jaundice along with generalized itching sensations. The studies, using the ultrasonogram and the CAT scan, showed that the intra- and extra-hepatic biliary trees were moderately dilated due to a mass effect at the distal portion of the common bile duct (Figure 2). The ERCP revealed the lesion was malignant(Figure 3), and histologically confirmed adenocarcinima, well differentiated. He underwent Whipple's pancreaticoduodenectomy with regional lymph node dissection(Figure 4). The histopathological examination revealed that the lesion was adenocarcinoma, moderately differentiated, with lymphatic and perineural invasion, in the distal portion of the common bile duct (Figure 5). The malignancy extended toward the submucosal layer of duodenum and the pancreatic parenchyme. The resected margin of common bile duct was free from malignant invasion. He recovered uneventfully from the second surgical intervention. He periodically visits the out-patient Department of Surgery nowadays.