Middle bile duct cancer with portal vein tumor thrombus

Mitsugi Shimoda¹ , Yukihiro Iso¹ , Shigeki Tomita² , Takahiro Fujimori² , Koji Murakami³ , Tokihiko Sawada¹ and Keiichi Kubota¹

¹Department of Gastroenterological Surgery, Dokkyo University School of Medicine, Tochigi, Japan

²Department of Surgical Pathology, Dokkyo University School of Medicine, Tochigi, Japan

³P.E.T Center, Dokkyo University School of Medicine, Tochigi, Japan

author email corresponding author email

World Journal of Surgical Oncology 2008, 6:48doi:10.1186/1477-7819-6-48


Published:	10 May 2008

Abstract

Background

Tumor thrombus in the portal vein is a common complication of hepatocellular carcinoma, but an extremely rare complication of common bile duct cancer.

Case presentation

A 78-year-old woman was referred to our department because of jaundice. Laboratory data showed severe liver dysfunction with high serum levels of total bilirubin and CA19-9. Computed tomography showed lesions in the middle bile duct and main portal vein. FDG PET scan and 3D imaging showed hot spots in the same location as those revealed by CT. Under a diagnosis of middle bile duct cancer with portal vein tumor thrombus, the patient underwent surgery. At laparotomy, the main tumor was found to be located in the middle bile duct with a tumor thrombus, 2 cm in diameter, in the main portal vein. The patient underwent pancreatoduodenectomy with thrombectomy. Histological examination showed that this thrombus had the same histological features as those of the main bile duct cancer (poorly differentiated adenocarcinoma). The postoperative course was uneventful and the patient is doing well without any signs of recurrence 18 months after surgery.

Conclusion

To our knowledge, this is the first report of successful resection of middle bile duct cancer with portal vein tumor thrombus.