Common bile duct carcinoid mimicking the clinical, EUS, and ERCP findings of cholangiocarcinoma: a rare but potentially curable cause of obstructive jaundice
التفاصيل البيبلوغرافية
العنوان:
Common bile duct carcinoid mimicking the clinical, EUS, and ERCP findings of cholangiocarcinoma: a rare but potentially curable cause of obstructive jaundice
C A man presented with right upper quadrant pain and tenderness, progressive jaundice, and 20-kg weight oss, without episodic flushing, wheezing, or diarrhea, for 2 onths. Serum levels: lipase, 328 U/L; aspartate aminotransferse, 54 U/L; alanine aminotransferase, 119 U/L; alkaline phoshatase, 528 U/L; and total bilirubin, 3.9 mg/dL. Abdominal ltrasound revealed a 1.0-cm wide choledochus, without intraepatic lesions. Endoscopic retrograde cholangiopancreatography ERCP) revealed mid-distal choledochal stricture, with mild roximal choledochal dilatation. The stricture was dilated enoscopically, and a 7 French stent was deployed. Cross-sectional ndoscopic ultrasonography (EUS) with Doppler revealed a 1.5 1.2 m, irregularly spherical, hypoechoic mass (Figure A; arrows urround choledochal mass near ampulla; arrowhead, bright, yperechoic, parallel lines from choledochal stent within diated choledochal stricture; PV, portal vein; DW, duodenal wall). ytologic examinations of ductal brushings obtained at ERCP nd needle biopsies obtained at EUS were nondiagnostic. Seum carbohydrate antigen (CA) 19-9 level was 50 U/mL (minially elevated, normal 35 U/mL). Laparotomy, for presumed cholangiocarcinoma, revealed a .8-cm long, firm, mid-distal choledochal mass with choledchal thickening. A 2.5-cm area surrounding the mass was esected. Frozen sections of the resected specimen revealed ocally invasive cancer. The patient then underwent pancretoduodenectomy. Microscopic examination of permanent secions of resected specimen revealed low-grade, circumferential