Preoperative diagnosis of an asymptomatic cancer restricted to the cystic duct

Abstract

Introduction: Even now, cystic duct cancer (CDC) as defined by Farrar is rare and has a better prognosis than gallbladder cancer, although CDC as defined by Ozden et al., the definition of which could apply to early and advanced cases of CDC, is not rare and has a poorer prognosis than the CDC defined by Farrar.

Presentation of case: A 78-year-old woman with no complaints was found to have a tumor restricted to the cystic duct. Three cytology examinations of the patient's bile could not establish that the tumor was an adenocarcinoma. However, adenocarcinoma was suspected due to the hypervascularity shown on contrast-enhanced computed tomography. Cholecystectomy and extrahepatic bile duct resection with D2 lymph node dissection was performed. The pathological study revealed it to be CDC. Her postoperative course has been uneventful and without recurrence for 21 months.

Discussion: At their first medical examination, many CDC patients are found to have such advanced spread of the cancer to adjacent organs that an extended operation might be necessary. As in our case, better patient outcome results when no lymph node or remote metastasis is present.

Conclusion: Diagnosing CDC as early as possible contributes to curative resections and favorable patient outcomes and also allows surgeons to recommend a mini-invasive procedure to their patients rather than extended resection including that of adjacent organs.

Keywords: Curative surgery; Cystic duct cancer; Preoperative diagnosis.

Fig. 1

Enhanced computed tomography showed a hypervascular tumor, 10 mm in diameter, in the cystic duct.

Fig. 2

Ultrasonography also showed a tumor of 10 mm in diameter in the cystic duct.

Fig. 3

Endoscopic retrograde cholangiopancreatography showed an obstruction of the cystic duct.

Fig. 4

The surgically resected specimen comprised a 6.0 mm × 5.0-mm nodular infiltrating tumor (arrow) surrounded by a shallow ulcer, 11 mm × 10 mm in diameter, restricted to the cystic duct.

Fig. 5

The pathological study revealed the presence of a moderately differentiated tubular adenocarcinoma (arrows). The dotted arrow indicates the gallbladder wall, which contained no malignant cells. (H and E staining, 40×).