Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2023; 15(3): 562-570
Published online Mar 15, 2023. doi: 10.4251/wjgo.v15.i3.562
Carcinosarcoma of common bile duct: A case report
Shu-Yan Mao, Ming Xu, Lei Jin, Hong-Gang Xiang, Yao Yao
Yao Yao, Ming Xu, Division of Gastroenterology and Hepatology, Shanghai Pudong New Area People’s Hospital, Shanghai University of Medicine and Health Sciences, Shanghai 200120, China
Hong-Gang Xiang, Division of General Surgery, Shanghai Pudong New Area People’s Hospital, Shanghai University of Medicine and Health Sciences, Shanghai 200120, China
Lei Jin, Shu-Yan Mao, Division of Pathology, Shanghai Pudong New Area People’s Hospital, Shanghai University of Medicine and Health Sciences, Shanghai 200120, China
Author contributions: Yao Y authored the manuscript; Xu M co-authored the manuscript and contributed to the formulation of the diagnosis and treatment plan; Xiang HG performed the surgical treatment; Jin L and Mao SY provided the diagnosis of pathology.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming Xu, MD, Chief Physician, Division of Gastroenterology and Hepatology, Shanghai Pudong New Area People’s Hospital, Shanghai University of Medicine and Health Sciences, No. 470 Chuanhuan South Road, Shanghai 200120, China. xm73dr@163.com
Received: October 1, 2022
Peer-review started: October 1, 2022
First decision: January 9, 2023
Revised: January 15, 2023
Accepted: March 3, 2023
Article in press: March 3, 2023
Published online: March 15, 2023
Processing time: 164 Days and 3.6 Hours
Abstract
BACKGROUND

Carcinosarcomas of the common bile duct (CBD) are an extremely rare finding in the clinical setting. Based on a review of 12 literatures, 3 cases had the imaging features of ossification. Carcinosarcomas are prone to distant metastasis, as they possess clinical features of both carcinoma and sarcoma, and generally have with a poor prognosis. Due to the small number of cases reported, clinical experience in the diagnosis and treatment of the disease is lacking.

CASE SUMMARY

The patient was a 75-year-old woman who had experienced recurrent chills with nausea and vomiting for 3 mo. Computed tomography, magnetic resonance imaging, endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography led to the diagnosis of malignant tumor of the CBD. The patient ultimately underwent cholecystectomy, CBD resection, and choledochojejunostomy. Postoperative pathological examination revealed carcinosarcoma of the CBD, and the latest follow-up showed that the patient is recovering well. Based on previous case reports, some carcinosarcoma has ossification characteristics in imaging. If it is misdiagnosed as biliary calculi, the use of laser lithotripsy in surgery may lead to tumor diffusion. Choledochoscopy and narrow band staining of mucosa are very important for diagnosis.

CONCLUSION

We herein present a rare case of carcinosarcomas of the CBD, we found the tumours may have imaging features of polypoid growth and ossification only when the sarcomal components are bone differentiation, while show soft tissue shadow when non bone differentiation. Confirmation of diagnosis depends greatly upon postoperative pathological examination and the adjuvant treatment has not been established, which leads to the poor prognosis.

Keywords: Carcinosarcoma; Sarcocarcinoma; Sarcomatoid carcinoma; Extrahepatic bile duct tumor; Common bile duct tumor; Case report

Core Tip: Carcinosarcomas of the common bile duct are extremely rare. Polypoid growth and ossification in the tumor could be representative features in cases of the sarcomal components being differentiated from bone. If misdiagnosed as biliary calculi, the use of laser lithotripsy may lead to tumor diffusion. Our case showed soft tissue exclusively on imaging and was initially misdiagnosed as acute cholangitis, highlighting the critical dependence of diagnosis confirmation on postoperative pathological examination, which itself is important for establishment of adjuvant treatment and the consequent prognosis. Other critical investigations to avoid misdiagnosis are choledochoscopy and narrow band staining of mucosa.