Rapid progression of sarcomatoid carcinoma of the common bile duct

Moon Jin Kim, Jun Suh Lee, Yu Mi Kim, Soyeon An, Young Chul Yoon
2019 Korean Journal of Clinical Oncology  
Sarcomatoid carcinoma is a rare malignant spindle cell neoplasm in which epithelial differentiation may be demonstrated by immunohistochemical or ultrastructural studies [1, 2] . These tumors have been reported in many different organs, including esophagus, lung, liver, stomach, gallbladder, pancreas, small intestine, urinary tract, and uterus. Though well defined, histopathological sarcomatoid carcinoma occurring in the common bile duct (CBD) is extremely rare; and its clinical behavior and
more » ... gnosis are unclear. Generally, sarcomatoid carcinoma is known to have poorer prognosis than carcinoma. There is a few report where bile duct sarco-matoid carcinoma has better prognosis than in gallbladder carcinoma [3] . We report a case of sarcomatoid carcinoma in the CBD that progressed rapidly after surgery. A 65-year-old female patient was visited for further management of jaundice with vague abdominal pain. She had elevated liver enzymes (total bilirubin, 7.9 mg/dL; aspartate aminotransferase, 231 U/L; alanine aminotransferase, 311 U/L; alkaline phosphate, 143 U/L). Her tumor marker levels were mildly elevated in carbohydrate antigen 19-9 (50.5 U/mL) and otherwise normal (alpha-fetoprotein, 2.85 ng/mL; carcinoembryonic antigen, 1.16 ng/mL). Contrast enhanced chest-abdomen-pelvis computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) were performed for diagnosis and oncologic staging. CT and ERCP showed longitudinal narrowing in mid CBD (Fig. 1) . Brush cytology smears from the distal bile duct showed atypical cell, suggesting adenocarcinoma. We did not perform liver magnetic resonance imaging because there was no suspicion of liver metastasis on CT. Preoperative imaging stage was T2 or T3N0M0. Case Report Korean Journal of Clinical Oncology 2019;15:40-45 https://doi. Since sarcomatoid carcinoma in the common bile duct (CBD) is rarely reported, the clinical course and prognosis after surgery are unclear. We report a case of a patient who died within 1 month after surgery due to rapid tumor progression. A 65-year-old woman had abdominal pain with jaundice. She was diagnosed with CBD cancer and underwent pancreatoduodenectomy. Pathologic examination revealed sarcomatoid carcinoma. There was no postoperative complication, but multiple liver metastasis was diagnosed on computed tomography at 7 days after surgery. Also, the patient complained of abdominal pain and had jaundice with elevated liver enzyme on the 14th postoperative day. Her general condition was getting worse and she died of hepatic failure 23 days after surgery. We report a case of sarcomatoid carcinoma of the CBD that progressed very rapidly. Further research and case reports are needed to establish proper diagnostic and treatment tools.
doi:10.14216/kjco.19008 fatcat:rkotkzwcwjcmhcjugzut63afbq