Case Report
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2005; 11(41): 6554-6556
Published online Nov 7, 2005. doi: 10.3748/wjg.v11.i41.6554
Peroral cholangioscopy for non-invasive papillary cholangiocarcinoma with extensive superficial ductal spread
Toshifumi Wakai, Yoshio Shirai, Katsuyoshi Hatakeyama
Toshifumi Wakai, Yoshio Shirai, Katsuyoshi Hatakeyama, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Yoshio Shirai, MD, PhD, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, Niigata 951-8510, Japan. shiray@med.niigata-u.ac.jp
Telephone: +81-25-227-2228 Fax: +81-25-227-0779
Received: January 6, 2005
Revised: January 23, 2005
Accepted: January 26, 2005
Published online: November 7, 2005
Abstract

Papillary carcinoma arising from the extrahepatic bile duct often shows superficial ductal spread. We report herein the case of a patient with extensive superficial spread of non-invasive papillary cholangiocarcinoma, which was depicted with peroral cholangioscopy. A 65-year-old woman presented with the sudden-onset of severe epigastric pain. Ultrasonography revealed acute acalculous cholecystitis. Endoscopic retrograde cholangiography found small protruding lesions around the confluence of the cystic duct, suggestive of a cholangiocarcinoma. As the contour of the middle and upper bile ducts it was slightly irregular on the cholangiogram, the presence of superficial ductal spread was suspected. Peroral cholangioscopy revealed small papillary lesions around the confluence of the cystic duct and fine granular mucosal lesions in the middle and upper bile ducts and the right hepatic duct, suggesting a superficially spreading tumor. A right hepatectomy with bile duct resection was performed and no residual tumor was found. Histological examination revealed a non-invasive papillary carcinoma arising from the cystic duct with extensive superficial spread. Our experience of this case and a review of the literature suggest that a fine granular or fine papillary appearance of the ductal mucosae on cholangioscopy indicates superficial spread of papillary cholangiocarcinoma, for which peroral cholangioscopy is an efficient diagnostic option.

Keywords: Cholangiocarcinoma; Bile duct neoplasms; Peroral cholangioscopy; Papillary carcinoma; Superficial ductal spread; Surgery