J CIin Gastroenterol 1992;15(2):13&41.
"1992 Raven Press, Ltd., New York
Synchronous Cancer of the Biliary Tract and Pancreas Associated with Anomalous Arrangement of the Pancreaticobiliary Ductal System Nobuhiko Ueda, M.D., Takukazu Nagakawa, M.D., Tetsuo Ohta, M.D., Masato Kayahara, M.D., Keiichi Ueno, M.D., Ichiroh Konishi, M.D., Ryouhei Izumi, M.D., and Itsuo Miyazaki, M.D.
A 58-year-old man on abdominal ultrasonography and CT had an irregularly elevated lesion at the neck of the gallbladder and a cyst of -6.5 cm in diameter at the pancreatic tail. Percutaneous transhepatic cholangiography revealed a 2-cm shadow defect at the neck of the gallbladder and an irregular, translucent 30 x 12 mm lesion in the intrapancreatic bile duct. Total pancreatectomy and extended cholecystectomy with regional lymph node dissection was performed. An anomalous arrangement of the pancreaticobiliary ductal system (AAPBD) was demonstrated by postoperative contrast radiography of resected specimen. The lesions of the gallbladder and common bile duct were papillary adenocarcinoma. In addition, papillary adenocarcinoma was limited almost entirely to the mucosal layer of the main pancreatic duct and its branches, from the junction of the common bile duct and pancreatic duct to the pancreatic tail. The three tumors were not continuous. The cyst at the pancreatic tail was a pseudocyst. This case represents synchronous cancer of the gallbladder, common bile duct, and pancreas associated with AAPBD. Key Words: Anomalous arrangement of the pancreaticobiliary ductal system-Synchronous cancer of the biliary tract and pancreas.
An anomalous arrangement of the pancreaticobiliary ductal system (AAPBD), which forms the so-called elongated common terminal duct, and in which the bile duct and pancreatic duct join too soon at a position distant from the duodenal papilla, has now often been described thanks to the increasing use of endoscopic retrograde cholangiopancreatography (ERCP). Although carcinoma occurring in the biliary tract associated with AAPBD has been reported (l), carcinoma of the pancreas associated with AAPBD has rarely been reported. We report a case of synchronous cancer of the gallbladder, common bile duct, and pancreas associated with AAPBD in a patient w h o has survived for almost 4 years. We also address the relationship between AAPBD and carcinogenesis in the pancreaticobiliary system.
CASE REPORT A 58-year-old man complained of epigastric and back pain for some months. When a cystic lesion of the pancreatic tail and an elevated lesion in the gallbladder were identified, the patient was admitted. On physical examination, neither anemia nor icterus were present. The abdomen was soft and flat, but a mass, which was probably the gallbladder, was palpable in the right hypochondrium. Laboratoxy findings on admission, such as blood count, electrolyte, and liver function did not reveal any abnormalities. But the serum amylase level of 407 IUD-, urine amylase level of 6,164 IUL, and amylase clearance/ creatinine clearance (ACCR) of 5.5% were all abnormal. Oral glucose tolerance test (OG?T) revealed a diabetic pattern and pancreatic function diagnostant (PFD) de-
From the Second Department of Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan. Address correspondence and reprint requests to Dr. N. Ueda at Second Department of Surgery, School of Medicine, Kanazawa University, 13-1 Takara-mach, Kanazawa 920, Japan.
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"1992 Raven Press, Ltd., New York
Synchronous Cancer of the Biliary Tract and Pancreas Associated with Anomalous Arrangement of the Pancreaticobiliary Ductal System Nobuhiko Ueda, M.D., Takukazu Nagakawa, M.D., Tetsuo Ohta, M.D., Masato Kayahara, M.D., Keiichi Ueno, M.D., Ichiroh Konishi, M.D., Ryouhei Izumi, M.D., and Itsuo Miyazaki, M.D.
A 58-year-old man on abdominal ultrasonography and CT had an irregularly elevated lesion at the neck of the gallbladder and a cyst of -6.5 cm in diameter at the pancreatic tail. Percutaneous transhepatic cholangiography revealed a 2-cm shadow defect at the neck of the gallbladder and an irregular, translucent 30 x 12 mm lesion in the intrapancreatic bile duct. Total pancreatectomy and extended cholecystectomy with regional lymph node dissection was performed. An anomalous arrangement of the pancreaticobiliary ductal system (AAPBD) was demonstrated by postoperative contrast radiography of resected specimen. The lesions of the gallbladder and common bile duct were papillary adenocarcinoma. In addition, papillary adenocarcinoma was limited almost entirely to the mucosal layer of the main pancreatic duct and its branches, from the junction of the common bile duct and pancreatic duct to the pancreatic tail. The three tumors were not continuous. The cyst at the pancreatic tail was a pseudocyst. This case represents synchronous cancer of the gallbladder, common bile duct, and pancreas associated with AAPBD. Key Words: Anomalous arrangement of the pancreaticobiliary ductal system-Synchronous cancer of the biliary tract and pancreas.
An anomalous arrangement of the pancreaticobiliary ductal system (AAPBD), which forms the so-called elongated common terminal duct, and in which the bile duct and pancreatic duct join too soon at a position distant from the duodenal papilla, has now often been described thanks to the increasing use of endoscopic retrograde cholangiopancreatography (ERCP). Although carcinoma occurring in the biliary tract associated with AAPBD has been reported (l), carcinoma of the pancreas associated with AAPBD has rarely been reported. We report a case of synchronous cancer of the gallbladder, common bile duct, and pancreas associated with AAPBD in a patient w h o has survived for almost 4 years. We also address the relationship between AAPBD and carcinogenesis in the pancreaticobiliary system.
CASE REPORT A 58-year-old man complained of epigastric and back pain for some months. When a cystic lesion of the pancreatic tail and an elevated lesion in the gallbladder were identified, the patient was admitted. On physical examination, neither anemia nor icterus were present. The abdomen was soft and flat, but a mass, which was probably the gallbladder, was palpable in the right hypochondrium. Laboratoxy findings on admission, such as blood count, electrolyte, and liver function did not reveal any abnormalities. But the serum amylase level of 407 IUD-, urine amylase level of 6,164 IUL, and amylase clearance/ creatinine clearance (ACCR) of 5.5% were all abnormal. Oral glucose tolerance test (OG?T) revealed a diabetic pattern and pancreatic function diagnostant (PFD) de-
From the Second Department of Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan. Address correspondence and reprint requests to Dr. N. Ueda at Second Department of Surgery, School of Medicine, Kanazawa University, 13-1 Takara-mach, Kanazawa 920, Japan.
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