Metastatic Common Bile Duct Cancer from Pulmonary Adenocarcinoma Presenting as Obstructive Jaundice

In Hye Cha; Jin Nam Kim; You Sun Kim; Soo Hyung Ryu; Jeong Seop Moon; Hye Kyung Lee

doi:10.4166/kjg.2013.61.1.50

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Cha, Kim, Kim, Ryu, Moon, and Lee: Metastatic Common Bile Duct Cancer from Pulmonary Adenocarcinoma Presenting as Obstructive Jaundice

Case Report

Korean J Gastroenterol 2013;61(1):50-53.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.61.1.50

Metastatic Common Bile Duct Cancer from Pulmonary Adenocarcinoma Presenting as Obstructive Jaundice

In Hye Cha, Jin Nam Kim, You Sun Kim, Soo Hyung Ryu, Jeong Seop Moon, Hye Kyung Lee¹

Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

¹Department of Pathology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea

Correspondence to: Jin Nam Kim, Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, 85 Jeo-dong 2-ga, Jung-gu, Seoul 100-032, Korea. Tel: +82-2-2270-0012, Fax: +82-2-2270-0257, E-mail: nammi39@freechal.com

Received 17 February 20122 April 2012 Accepted 3 April 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report an extremely rare case of metastatic common bile duct cancer from pulmonary adenocarcinoma presenting as obstructive jaundice. The patient was a 76-year-old male, who presented with generalized weakness and right upper quadrant pain. Plain chest X-ray noted multiple small nodules in both lung fields. Abdominal computed tomography scan showed a stricture of the mid common bile duct along with ductal wall enhancement. Endoscopic retrograde cholangiography revealed a concentric, abrupt narrowing of the mid-common bile duct suggestive of primary bile duct cancer. However, pathology comfirmed metastatic common bile duct cancer arising from pulmonary adenocarcinoma with immunohistochemical study with thyroid transcriptional factor-1 (TTF-1).

Keywords: Common bile duct neoplasms, Neoplasm metastasis, Lung adenocarcinoma, Obstructive jaundice, TTF-1

References

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Fig. 1.

Plain chest X-ray. Multiple small nodules were found in both lung parenchyma.

Fig. 2.

Abdominal CT scan. (A) Ductal wall enhancement (arrow) was seen on axial image. (B) Note the stricture at the mid-common bile duct along with shouldering and ductal wall enhancement (arrow) on coronal image.

Fig. 3.

Imaging and histologic findings of the common bile duct. (A) Endoscopic retrograde cholangiography revealed a concentric, abrupt narrowing of the mid-common bile duct. (B) Biopsy exhibited clusters of malignant columnar cells with prominent nucleoli and intracytoplasmic mucin vacuoles (H&E, ×400). (C) Adenocarcinoma cells demonstrated strong nuclear immunoreactivity for thyroid transcriptional factor-1 (×400).

Fig. 4.

Bronchoscopic findings and bronchial biopsy specimen. (A) Bronchoscopy showed hyperemic mucosal change, finding suspicious of cancer cell infiltration. (B) Biopsy revealed haphazardly infiltrating nests of adenocarcinoma cells with intracytoplasmic mucin production (H&E,×200). (C) Adenocarcinoma cells were also reactive for thyroid transcriptional factor-1 (×400).

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ORCID iDs: You Sun Kim
https://orcid.org/http://orcid.org/0000-0002-5156-3458
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