Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2019; 7(2): 215-220
Published online Jan 26, 2019. doi: 10.12998/wjcc.v7.i2.215
Concomitant adenosquamous carcinoma and cystadenocarcinoma of the extrahepatic bile duct: A case report
Bing-Jie Lu, Xue-Dong Cao, Nong Yuan, Ning-Ning Liu, Nisma L Azami, Ming-Yu Sun
Bing-Jie Lu, Nong Yuan, Nisma L Azami, Ming-Yu Sun, Key Laboratory of Liver and Kidney Diseases, Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Xue-Dong Cao, Department of Hepatobiliary Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Ning-Ning Liu, Department of Oncology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Author contributions: Lu BJ and Sun MY wrote the manuscript and were involved with project concept and submission; Cao XD, Yuan N and Liu NN analyzed the patient’s clinical data; Sun MY and Azami NL revised the manuscript; All authors approved the final version of this manuscript.
Supported by the Major Project of Shanghai Municipal S and T Commission, No. 15DZ1900104; Shanghai Key Laboratory of Traditional Chinese Clinical Medicine, Key Disciplines of Liver and Gallbladder Diseases and Key Laboratory of Chronic Deficiency Liver Disease of State Administration of Traditional Chinese Medicine of the People’ s Republic of China.
Informed consent statement: This study was reviewed and approved as a retrospective case review by the Institutional Review Board of Shuguang Hospital, Shanghai, China, with informed consent from the patient waived.
Conflict-of-interest statement: There are no potential conflicts (financial, professional, or personal) of interest relevant to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ming-Yu Sun, MD, PhD, Professor, Key Laboratory of Liver and Kidney Diseases, Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Pudong New District, Shanghai 201203, China. mysun248@hotmail.com
Telephone: +86-21-20256520
Received: September 22, 2018
Peer-review started: September 23, 2018
First decision: November 14, 2018
Revised: December 4, 2018
Accepted: December 14, 2018
Article in press: December 15, 2018
Published online: January 26, 2019
Abstract
BACKGROUND

Infiltrative adenosquamous carcinoma (ASC) of the extrahepatic bile duct is reported infrequently, which is an unusual variant of the ordinary adenocarcinoma. The simultaneous development of ASC and cystadenocarcinoma in the extrahepatic biliary tree is rare. In addition, the accurate preoperative diagnosis of concomitant carcinoma in the multiple biliary trees at an early stage is often difficult. Thus, awareness of the risk of the multiplicity of biliary tumors is perhaps the most important factor in identifying these cases.

CASE SUMMARY

Here, we report a case of a 63-year-old female with jaundice, who was referred to Shuguang Hospital because of abdominal pain for 1 mo. An abdominal contrast-enhanced computed tomography revealed a type I choledochal cyst and intraluminal masses suggestive of adenoma of the common bile duct. In addition, a preoperative diagnosis of a concomitant Klatskin tumor and type I choledochal cyst was made. The patient underwent anti-inflammatory therapy, followed by radical surgery due to hilar cholangiocarcinoma and resection of the choledochal cyst. Examination of the surgical specimen revealed a papillary tumor of the common bile duct, which arose from the malignant transformation of a pre-existing cystadenoma. Histologic examination confirmed a special type of cholangiocarcinoma; the tumor in the hilar bile duct was an ASC, whereas the tumor in the common bile duct was a moderately differentiated cystadenocarcinoma. The patient showed rapid deterioration 8 mo after surgery.

CONCLUSION

Although concomitant ASC and cystadenocarcinoma of the extrahepatic bile duct is difficult to diagnose before surgery, and the prognosis is poor after surgery, surgical resection is still the preferred treatment.

Keywords: Extrahepatic bile duct, Adenosquamous carcinoma, Klatskin tumor, Common bile duct, Cystadenocarcinoma, Case report

Core tip: We describe a patient with adenosquamous carcinoma of the hilar bile duct associated with cystadenocarcinoma of the common bile duct, who was treated with surgery. Although concomitant adenosquamous carcinoma and cystadenocarcinoma of the extrahepatic bile duct is difficult to diagnose before surgery, and the prognosis is poor after surgery, surgical resection is still the preferred treatment.