Adenocarcinoma developed from remnant cystic duct after cholecystectomy

BMC Gastroenterology

Eun Young Ze¹  Yoo Shin Choi²  Jae Hyuk Do¹ 

[1] Department of Internal Medicine, Chung-Ang University Hospital, 224-1, Heuk Seok-Dong, Dongjak-Ku, Seoul 156-755, South Korea;Department of Surgery, Chung-Ang University Hospital, 224-1, Heuk Seok-Dong, Dongjak-Ku, Seoul 156-755, South Korea

关键词: Postcholecystectomy;    Adenocarcinoma;    Remnant cystic duct;   

Others  :  1121789
DOI  :  10.1186/1471-230X-14-175

 received in 2014-05-19, accepted in 2014-09-24,  发布年份 2014

【 摘 要 】

Background

Cystic duct adenocarcinoma is a rare disease because the cystic duct has a short length and a narrow cavity. Cystic duct adenocarcinoma accounts for 8% of all gallbladder adenocarcinoma; of these, adenocarcinoma that develops from the remnant cystic duct after cholecystectomy is extremely rare. We report a case of incidentally detected adenocarcinoma that developed from the remnant cystic duct in a patient with history of cholecystectomy.

Case presentation

A 74-year-old Korean woman visited our hospital with abdominal pain. Her past medical history included cholecystectomy for acute cholecystitis with gallstones 10 years previously. Imaging of the abdomen demonstrated inflammation of the remnant cystic duct with multiple impacted stones. Complete removal of the remnant cystic duct with stones was performed. The pathologic report showed severe inflammation with abscess formation and an unexpected adenocarcinoma that appeared to invade the perimuscular connective tissue. The second operation (confirmation of the resection margin of the remnant cystic duct, wedge resection of the liver, and lymphadenectomy) was performed due to suspicion of pT2. There were no cancer cells in the resection margin of the remnant cystic duct, liver, or lymph nodes (0/6). The final histopathological diagnosis was pT2N0M0. She recovered without any complications. The patient is still living 1 year after surgery without recurrence or metastasis.

Conclusions

We report a rare case of adenocarcinoma that developed from the remnant cystic duct in a patient who underwent cholecystectomy.

【 授权许可】

   
2014 Do et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Vaittinen E: Carcinoma of the cystic duct. Ann Chir Gynaecol Fenn 1972, 61(3):190-194.
• [2]Noji T, Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Katoh H: Carcinoma of the cystic duct remnant with direct colonic invasion. Int J Gastrointest Cancer 2003, 34(2–3):117-120.
• [3]Eum JS, Kim GH, Park CH, Kang DH, Song GA: A remnant cystic duct cancer presenting as a duodenal submucosal tumor. Gastrointest Endosc 2008, 67(6):975-976.
• [4]Turner MA, Fulcher AS: The cystic duct: normal anatomy and disease processes. Radiographics 2001, 21(1):3-22.
• [5]Cetta F, Baldi C, Montalto G, Zuckermann M, Gori M, Piro P, Cariati A, Garotta F: Role of bile acid prophylaxis in the prevention of recurrent cholesterol stones forming in the cystic remnant after laparoscopic cholecystectomy: A prospective study with a minimum follow-up of 3 years. Gastroenterology 1998, 114(4):A.
• [6]Sahoo MR, Kumar A: Stump stone 6 years after cholecystectomy: a possibility. BMJ Case Rep 2013. online
• [7]Chan KM, Yeh TS, Tseng JH, Liu NJ, Jan YY, Chen MF: Clinicopathological analysis of cystic duct carcinoma. Hepatogastroenterology 2005, 52(63):691-694.
• [8]Cariati A, Piromalli E, Cetta F: Gallbladder cancers: associated conditions, histological types, prognosis, and prevention. Eur J Gastroenterol Hepatol 2014, 26(5):562-569.
• [9]Farrar DA: Carcinoma of the cystic duct. Br J Surg 1951, 39(154):183-185.
• [10]Ozden I, Kamiya J, Nagino M, Uesaka K, Oda K, Sano T, Kamiya S, Nimura Y: Cystic duct carcinoma: a proposal for a new “working definition”. Langenbecks Arch Surg 2003, 387(9–10):337-342.
• [11]Wehrmann T, Riphaus A, Martchenko K, Kokabpick S, Pauka H, Stergiou N, Frenz MB: Intraductal ultrasonography in the diagnosis of Mirizzi syndrome. Endoscopy 2006, 38(7):717-722.
• [12]Holzinger F, Schilling M, Z’Graggen K, Stain S, Baer HU: Carcinoma of the cystic duct leading to obstructive jaundice. A case report and review of the literature. Dig Surg 1998, 15(3):273-278.
• [13]Chijiiwa K, Torisu M: Primary carcinoma of the cystic duct. J Clin Gastroenterol 1993, 16(4):309-313.
• [14]Gerhards MF, van Gulik TM, Gonzalez Gonzalez D, Rauws EA, Gouma DJ: Results of postoperative radiotherapy for resectable hilar cholangiocarcinoma. World J Surg 2003, 27(2):173-179.
• [15]Todoroki T, Ohara K, Kawamoto T, Koike N, Yoshida S, Kashiwagi H, Otsuka M, Fukao K: Benefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma. Int J Radiat Oncol Biol Phys 2000, 46(3):581-587.
• [16]Fritz P, Brambs HJ, Schraube P, Freund U, Berns C, Wannenmacher M: Combined external beam radiotherapy and intraluminal high dose rate brachytherapy on bile duct carcinomas. Int J Radiat Oncol Biol Phys 1994, 29(4):855-861.