A surgical case of metachronous double cancer of the gallbladder and the common bile duct

Abstract

Reported cases of the metachronic double cancer have been increasing because of the increase in the elderly population and the improving diagnostic capabilities in image diagnosis. However, metachronic double cancer of the biliary tract is rare. We report a rare case of metachronous double cancer of the biliary tract without pancreaticobiliary maljunction. An 80-year-old woman was admitted to our hospital with jaundice. She had undergone extended cholecystectomy for gallbladder carcinoma pathologically diagnosed as tubular adenocarcinoma with lymph node metastasis 30 years previously. Abdominal CT demonstrated enhanced mass in the common bile duct, and dilatation of the proximal bile duct. For diagnosis of bile duct cancer, we performed pylorus-preserving pancreaticoduodenectomy. The pathological diagnosis of the resected specimen was well-differentiated adenocarcinoma involving the pancreas and duodenum. The main pancreatic duct and bile duct were detected separately. Biliary intraepithelial neoplasia (BilIN) was observed in the resected bile duct. The normal epithelium, BilIN 2, and BilIN 3 coexisted at the resected margin of the bile duct. This case was clarified as a metachronous double cancer. She is doing well 4 years after her second surgery, without recurrence.