MULTIPLE EARLY BILE-DUCT CARCINOMA-ASSOCIATED WITH CONGENITAL CHOLEDOCHAL CYST

Emergency ultrasonography showed a protruding tumor in the markedly di lated common bile duct of a 33-year-old Japanese woman. Magnetic reson ance cholangiopancreatography also demonstrated the tumor clearly, alm ost as clearly as did percutaneous transhepatic cholangiography. With a diagnosis of com mon bile duct carcinoma associated with congenital choledochal cyst, pancreaticoduodenectomy was performed. In the resect ed specimen, as well as the protruding tumor, there was also a small s lightly elevated lesion. Pathology examination showed adenocarcinoma l imited to the fibromuscular layer in the protruding tumor, and adenoca rcinoma limited to the mucosa in the elevated lesion. Prophylactic tot al excision of the choledochal cyst before the occurrence of malignant change is strongly recommended in patients with congenital choledocha l cyst. However, in those who are reluctant to undergo the operation, periodic follow-up with ultrasonography and magnetic resonance cholang iopancreatography would be ideal to achieve early detection of maligna nt change.