Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Aug 7, 2008; 14(29): 4705-4708
Published online Aug 7, 2008. doi: 10.3748/wjg.14.4705
Carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct: A case report
Bum-Soo Kim, Sun-Hyung Joo, Kwang-Ro Joo
Bum-Soo Kim, Sun-Hyung Joo, Department of Surgery, East-West Neo Medical Center, University of KyungHee College of Medicine, 149 Sangil-dong Gangdong-gu, Seoul 134-727, Korea
Kwang-Ro Joo, Department of Internal Medicine, East-West Neo Medical Center, University of KyungHee College of Medicine, 149 Sangil-dong Gangdong-gu, Seoul 134-727, Korea
Author contributions: Kim BS and Joo SH contributed equally to the paper; Joo KR performed the endoscopic evaluation.
Correspondence to: Sun-Hyung Joo, Division of Hepatobiliary Surgery, Department of Surgery, East-West Neo Medical Center, University of KyungHee College of Medicine, 149 Sangil-dong Gangdong-gu, Seoul 134-727, Korea. sunhyung@chol.com
Telephone: +82-2-4406135
Fax: +82-2-4406295
Received: February 27, 2008
Revised: April 10, 2008
Accepted: April 17, 2008
Published online: August 7, 2008
Abstract

Tubulovillous adenomas are common in the colon and rectum, but are rare in the common bile duct. Biliary adenomas may produce obstructive jaundice, which can be easily confused with a malignant neoplasm or stone. We report a case of a carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct causing obstructive jaundice. A 55-year-old male presented with a 10-d history of pruritus and progressive jaundice. Abdominal sonography and computed tomography showed a mass in the distal common bile duct. Endoscopic retrograde cholangiopancreatography showed luminal narrowing of the bile duct due to a polypoid mass. Positron emission tomography demonstrated no abnormal uptake. It was thought that this mass was a malignant tumor, thus a pylorus-preserving panceaticoduodenectomy was performed. The final pathology showed a tubulovillous adenoma with carcinoma in situ of the distal common bile duct. At follow-up 8 mo later, endoscopy showed multiple polyps in the rectum, colon and stomach. The polyps were removed by endoscopic mucosal resection and shown to be tubular adenomas with high grade dysplasia. Biliary adenomas require careful follow-up for early detection of recurrence and malignant transformation.

Keywords: Common bile duct; Adenoma; Carcinoma in situ