Lower Bile Duct Cancer with de novo Non-invasive Pancreatic Cancer and Intraductal Papillary Mucinous Neoplasm: A Case Report

We report a case of lower bile duct cancer with de novo non-invasive pancreatic cancer and small intraductal papillary mucinous neoplasm (IPMN). A 75-year-old man saw locally for elevated fever and jaundice in September 2003 was found liver function tests to have obstructive jaundice. ERCP showed severe stenosis of the lower bile duct, dilation of the upstream bile duct, and fine irregularity in the body of the pancreatic duct. Abdominal CT showed a dilated intraheptic biliary duct and small cysts in the pancreatic body. Cytology of bile juice showed class IV diagnosis highly suspicious of adenocarcinoma. Based on the diagnosis of lower bile duct cancer, we conducted pancreaticoduodenectomy with lymph node dissection and reconstruction using Imanaga's method. Microscopically, papillary adenocarcinoma was seen in the lower bile duct. de novo noninvasive papillary adenocarcinoma 2mm in size and changes of IPMN and mucosal cell hyperplasia in the main pancreatic duct and intraductal papillary mucinous adenomas 10mm in size in the branch of the pancreatic duct were found. Non-invasive pancreatic cancer is difficult to diagnose early, but fine abnormalities in ERCP or CT as seen in our case may lead to an early diagnosis of non-invasive pancreatic cencer.