Abstract
Spindle cell-type undifferentiated carcinoma arising from the extrahepatic bile duct is extremely rare. We herein report a case of this type of carcinoma in the common bile duct of the hepatic hilus. A 59-year-old man was admitted to our hospital complaining of jaundice. The laboratory data revealed an elevation of the serum carbohydrate antigen 19–9 level. Cholangiography revealed a complete obliteration of the left hepatic bile duct and stenosis of the bile duct from the superior to the right hepatic bile duct. Computed tomography showed the tumor to measure 15 × 12 mm in the hepatic hilus, with the obliteration of the right to main trunk of the portal vein and a swollen lymph node in the hepato-duodenum ligament. Arteriography revealed a kink of the right hepatic artery; therefore an encasement of the right hepatic artery was suspected. We preoperatively diagnosed hilus bile duct carcinoma and scheduled a right trisection hepatectomy. Intraoperative frozen sections taken from the tumor and tissues around the hepatic arteries showed spindle and inflammatory cells; therefore an inflammatory pseudotumor was diagnosed intraoperatively. As the right hepatic bile duct was occluded, a right lobe hepatectomy was performed. However, a permanent section revealed both spindle cells and poorly differentiated tubular adenocarcinoma cells positive for CAM5.2, AE1/AE3, and vimentin. On the basis of these findings, the tumor was finally diagnosed to be spindle cell-type undifferentiated carcinoma. Unfortunately, the patient died of pulmonary infarction 11 days after the operation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
J Albores-Saavedra DE Henson DS Klimstra (2000) Tumor of the gallbladder, extrahepatic bile ducts, and ampulla of Vater. Atlas of tumor pathology. Third series fascicle 27 Armed Forces Institute of Pathology Washington, D.C.
SR Hamilton LA Aaltonen (2000) World Health Organization classification of tumors. Pathology and genetics of tumors of the digestive system IARC Press Lyon
A Nonomura Y Mizukami F Matsubara H Ueda (1994) ArticleTitleA case of choledochal cyst associated with adenocarcinoma exhibiting sarcomatous features J Gatroenterol 29 669–75 Occurrence Handle10.1007/BF02365455 Occurrence Handle1:STN:280:ByqD1MzlvFI%3D
CY Yuan HW Lo CH Tseng T Takasaki F Hanyu (1995) ArticleTitleA case of spindle cell sarcomatous change of hepatic ducts manifesting as obstructive jaundice J Gastroenterol 30 264–7 Occurrence Handle7773359 Occurrence Handle10.1007/BF02348676 Occurrence Handle1:STN:280:ByqB1M7ktVc%3D
Y Mokuno T Katoh K Yoshida T Abe M Maeda H Chigira (2000) ArticleTitleUndifferentiated spindle cell carcinoma of the extrahepatic bile ducts Hepatogastroenterology 47 1234–7 Occurrence Handle11100321 Occurrence Handle1:STN:280:DC%2BD3Mzgs1yktA%3D%3D
E Nagai M Shinohara H Yonemasu H Kiahikawa M Tsuneyoshi (2002) ArticleTitleUndifferentiated carcinoma of the common bile duct J Hepatobiliary Pancreat Surg 9 627–31 Occurrence Handle12541051 Occurrence Handle10.1007/s005340200085
S Dowaki H Kijima H Kashiwagi K Tobita Y Ohtani Y Sugio et al. (2003) ArticleTitleUndifferentiated spindle and giant cell carcinoma of the common bile duct Tokai J Exp Clin Med 28 127–30 Occurrence Handle15055405
GS Yoon DL Choi (2004) ArticleTitleSarcomatoid carcinoma of common bile duct Hepatogastroenterology 51 106–9 Occurrence Handle15011841
J Albores-Saavedra DJ Grider J Wu DE Henson ZD Goodman (2006) ArticleTitleGiant cell tumor of the extrahepatic biliary tree. A clinicopathologic study of 4 cases and comparison with anaplastic spindle and giant cell carcinoma with osteoclast-like giant cells Am J Surg Pathol 30 495–500 Occurrence Handle16625096 Occurrence Handle10.1097/00000478-200604000-00010
M Kubo S Takao H Shinchi K Uchikura M Higashi S Yonezawa et al. (2000) ArticleTitleSpindle cell carcinoma of the pancreas J Hepatobiliary Pancreat Surg 7 236–41 Occurrence Handle10982621 Occurrence Handle10.1007/s005340050183 Occurrence Handle1:STN:280:DC%2BD3cvotF2jsQ%3D%3D
MK Chadha C LeVea M Javle B Kuvshinoff R Vijaykumar R Iyer (2004) ArticleTitleAnaplastic pancreatic carcinoma: a case report and review of literature JOP 5 512–5 Occurrence Handle15536293
K Nishihara M Tsuneyoshi (1993) ArticleTitleUndifferentiated spindle cell carcinoma of the gallbladder: a clinicopathologic, immunohistochemical, and flow cytometric study of 11 cases Hum Pathol 24 1298–305 Occurrence Handle8276377 Occurrence Handle10.1016/0046-8177(93)90263-G Occurrence Handle1:STN:280:ByuC3c3ntFw%3D
M Shimada K Takenaka T Rikimaru T Hamatsu Y Yamashita K Kajiyama et al. (2000) ArticleTitleCharacteristics of sarcomatous cholangiocarcinoma of the liver Hepatogastroenterology 47 956–61 Occurrence Handle11020857 Occurrence Handle1:STN:280:DC%2BD3cvmslCksQ%3D%3D
C Are M Gonen M D'Angelica RP DeMatteo Y Fong LH Blumgart et al. (2006) ArticleTitleDifferential diagnosis of proximal biliary obstruction Surgery 140 756–63 Occurrence Handle17084718 Occurrence Handle10.1016/j.surg.2006.03.028
EI Johnston RA Beach SM Waldrop D Lawson C Cohen (2006) ArticleTitleRapid intraoperative immunohistochemical evaluation of sentinel lymph nodes for metastatic breast carcinoma Appl Immunohistochem Mol Morphol 14 57–62 Occurrence Handle16540732 Occurrence Handle10.1097/01.pai.0000153722.21155.5f
IK Lee HD Lee J Jeong BW Park WH Jung SW Hong et al. (2006) ArticleTitleIntraoperative examination of sentinel lymph nodes by immunohistochemical staining in patients with breast cancer Eur J Surg Oncol 32 405–9 Occurrence Handle16524688 Occurrence Handle10.1016/j.ejso.2006.01.009
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nakanishi, Y., Ito, T., Kubota, K. et al. Spindle Cell-Type Undifferentiated Carcinoma of the Common Bile Duct of the Hepatic Hilus: Report of a Case. Surg Today 37, 708–712 (2007). https://doi.org/10.1007/s00595-007-3463-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-007-3463-2