The American Journal of Surgery 193 (2007) 738 –739
Clinical image
Restricted cystic duct carcinoma Fumihiko Miura, M.D., Ph.D.*, Tadahiro Takada, M.D., Ph.D., F.A.C.S., Hodaka Amano, M.D., Ph.D., Masahiro Yoshida, M.D., Ph.D. Department of Surgery, Teikyo University, School of Medicine 2-11-1, Kaga, Itabashi-ku, Tokyo, 173-8605 Japan Manuscript received June 13, 2006; revised manuscript September 4, 2006
An abdominal ultrasound on a routine physical examination of an asymptomatic 59-year-old man showed gallbladder enlargement. Contrast-enhanced computed tomography showed a mass in the cystic duct (Fig. 1). Endoscopic retrograde cholangiopancreatography showed complete obstruction of the cystic duct without abnormal findings of the common bile duct (Fig. 2). Under the diagnosis of restricted carcinoma of the cystic duct, a pancreatoduodenectomy with lymphadenectomy was performed. In the resected specimen, a nodular-type tumor measuring 12 ⫻ 3 mm was found in the cystic duct. The tumor was diagnosed histopathologically as a poorly differentiated tubular adenocarcinoma with infiltration into the subserosal layer, but with no lymph node metastasis (TNM classification: T2, N0, M0; stage IB). The postoperative course was uneventful and the patient is without recurrence at 5 years. Comments A primary cystic duct carcinoma was defined in 1951 by Farrar [1] by using the following criteria for diagnosis: (1)
Fig. 2. Endoscopic retrograde cholangiopancreatography showed complete obstruction of the cystic duct (arrow). There were no abnormal findings in the common bile duct.
Fig. 1. Contrast-enhanced computed tomography showing an enhancing mass (arrow) in the cystic duct. * Corresponding author. Tel.: ⫹81-3-3964-1228; fax: ⫹81-3-39622128. E-mail address:
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growth is restricted to the cystic duct, (2) no neoplastic process is present in the gallbladder, hepatic ducts, or the common bile duct, and (3) histologic confirmation of the presence of carcinoma cells in the mass. Carcinoma of the cystic duct is a rare neoplasm, with an incidence of 1.5% in patients with gallbladder cancer [2]. Because the features defined by Farrar [1] are observed only in the early stage, more advanced cystic duct carcinomas cannot be differentiated from other advanced biliary malignancies [3]. The preoperative diagnosis of cystic duct carcinoma is difficult because of the
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F. Miura et al. / The American Journal of Surgery 193 (2007) 738 –739
narrow lumen of the cystic duct and because patients with cystic duct carcinoma rarely have any symptoms or signs [4]. Often the gallbladder is enlarged uniformly; however, the incidence of cholelithiasis with this disease is less than that associated with gallbladder carcinoma [3]. In patients with gallbladder swelling without gallstones, the possibility of cystic duct carcinoma should be taken into consideration.
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References [1] Farrar DA. Carcinoma of the cystic duct. Br J Surg 1951;39:183–5. [2] Vaittinen E. Carcinoma of the cystic duct. Ann Chir Gynaecol Fenn 1972;61:190 – 4. [3] Shibata Y, Toyoda S. Carcinoma of the cystic duct protruding into the common bile duct: report of a case. Surg Today 1995;25:1050 –3. [4] Furukawa H, Muramatsu Y, Fukushima N, et al. Carcinoma of the cystic bile duct: MRCP and CT appearance. AJR Am J Roentgenol 1999;173:1141.
