THE CHOLANGIOCARCINOMA IN AN ADENOMA AFTE R HEPATICOJEJUNOSTOMY - A CASE-REPORT

Cholangiocarcinoma at the choledochoduodenal anastomosis site is a rar e complication. Our 71-years-old female patient developed an adenocarc inoma 38 years after cholecystectomy and choledochoduodenal anastomosi s. During the previous two years she suffered from recurrent episodes of cholangitis and jaundice. Multiple endoscopically obtained biopsies from a suspicious are at the anastomosis showed a tubular adenoma. Wi th a CA19-9 of 2,429 U/l laparotomy was performed with radical removal of the choledochoduodenostomy and the extrahepatic bile ducts and rec onstruction with hepaticojejunostomy. The histological examination rev ealed a poorly differenciated, partly solid, partly tubular adenocarci noma of the choledochal duct with metastasis of the lymph nodes in the hepatoduodenal ligament. According to the UICC staging system the tum or was pT2, G3, pN1 classified as stage III. Two months later the pati ent developed a peritoneal carcinosis with a CA19-9 of 15,050 U/l and died. The development of cholangiocarcinoma may be caused by chronic c holangitis, which may arise from several diseases of the bile ducts li ke choledochal cysts, primary sclerosing cholangitis or reflux of duod enal contents like in choledochoduodenal anastomoses. Because of the h eterogeneity inside the lesions a malignant lesion can only be exclude d by histopathological examination of the whole tumor.