Primary carcinoma of the cystic duct: a case report and review of classifications

Abstract

BackgroundThe incidence of extrahepatic bile duct malignancies is about 2–3.6% of all gastrointestinal malignancies. Primary carcinoma of cystic duct is a rare condition comprising a fraction of all extrahepatic bile duct malignancies with less than 70 cases reported worldwide. Majority of these cases were reported from East Asia. There is paucity in such case being reported from Indian subcontinent. We present a case of primary carcinoma of the cystic duct encountered during laparoscopic cholecystectomy.Case presentationA 65-year-old lady presented to us with symptomatic gall stone disease. Investigations revealed a distended gall bladder with multiple stones. Patient was taken up for laparoscopic cholecystectomy, during surgery a stony hard structure was found at cystic duct-common bile duct junction which was not amenable for clear dissection. Procedure was converted to open, and the patient underwent cholecystectomy with resection of common bile duct with Roux-en-Y hepaticojejunostomy and regional lymphadenectomy. Histopathological findings revealed it to be moderately differentiated adenocarcinoma of the cystic duct.ConclusionPrimary carcinoma of cystic duct is a rare condition where early diagnosis can be difficult and if accidentally detected may add to surgeon’s dilemma. Proper surgery with en-bloc resection of gallbladder, cystic duct, common bile duct, and regional lymphadenectomy is the mainstay of treatment. The prognosis of carcinoma of cystic duct is better than extrahepatic bile duct malignancies. The old classification system has outlived its time and is more rigid in definition which is not practical in advanced cases; the new classification systems of this century offer better insight into understanding the tumor characteristics and prognosis.

Early Detection of High-grade Biliary Intraepithelial Neoplasia (BilIN-3) in the Cystic Duct Visualized by SpyGlass DS Cholangioscopy

“…The recommended treatment for BilIN is radical surgery consisting of cholecystectomy with non-anatomical gallbladder fossa resection and excision of the extrahepatic bile duct with regional lymphadenectomy ( 3 , 6 ). The average survival time is 27.2 months, versus just 5.8 months for gallbladder carcinoma and 3.2-11.4 months for other extrahepatic biliary duct cancers ( 6 , 30 ) This is consistent with the finding that symptoms of cystic duct cancer may develop earlier than those of gallbladder cancer ( 31 ).…”

Cystic Duct Carcinoma: A New Classification System and the Clinicopathological Features of 62 Patients

“…Over the last two decades, some researchers have proposed their own classifications of CDC (6). In our clinical work, we found that CDC appears to be commonly associated with hilar involvement, and the extent of tumor invasion in the porta hepatis significantly affects resectability and patient prognosis.…”

The giant resectable carcinoma of gall bladder—a case report

“…The presence of jaundice, abdominal lump, anorexia, and weight loss are usually indicative of advanced stages. A mucocele of GB in absence of any stone may be early marker for malignancy arising in cystic duct or at neck [ 13 ]. GBC are rarely diagnosed before it has advanced or metastasized [ 14 ].…”