Choledochal Cyst with Intraductal Papillary Neoplasm of Common Bile Duct

Case Report

Austin J Clin Case Rep. 2016; 3(5): 1103.

Choledochal Cyst with Intraductal Papillary Neoplasm of Common Bile Duct

Chao-Wei Lee¹, Cheng-Wei Wang¹, Ming-Chin Yu¹*, Tse-Ching Chen² and Miin-Fu Chen¹

¹Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan

²Department of Pathology, Chang Gung Memorial Hospital, Linkou, Taiwan

*Corresponding author: Ming-Chin Yu, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan

Received: August 05, 2016; Accepted: October 28, 2016; Published: November 16, 2016

Abstract

Intraductal Papillary Neoplasm (IPN) of Common Bile Duct (CBD) is uncommon, but choledochal cyst coexisting with IPN of CBD is even rare. Due to rarity, the nature of this disease and its treatment outcome are not fully determined yet. We herein report a case of Todani type IV a choledochal cyst with concomitant invasive IPN of CBD.

Case Report

An 88-year-old male farmer suffered from intermittent right upper quadrant abdominal dull pain and fullness sensation for one month. Body weight loss of about 5 kg during this period was also noted. There was no fever, bowel habit change, or tea color urine. The physical examination revealed an 8 x 4 cm ill-defined mass at right upper quadrant of abdomen. No jaundice was found. Tumor markers were within normal range. Both contrast-enhanced computed tomography and Magnetic Resonance Cholangiopancreatography (MRCP) showed markedly dilated Common Bile Duct (CBD) and bilateral Intrahepatic Ducts (IHD) (Figures 1 and 2). Diffuse papillary tumors with slow progressive enhancement were noted within the dilated CBD. Multiple small gallstones were found as well. Todani type IVa choledochal cyst with malignant change was impressed. The patient received total excision of common bile duct, cholecystectomy, and Roux-en-Y hepaticojejunostomy as curative treatment.