Carcinosarcoma of common bile duct: A case report

Abstract

BACKGROUND Carcinosarcomas of the common bile duct (CBD) are an extremely rare finding in the clinical setting. Based on a review of 12 literatures, 3 cases had the imaging features of ossification. Carcinosarcomas are prone to distant metastasis, as they possess clinical features of both carcinoma and sarcoma, and generally have with a poor prognosis. Due to the small number of cases reported, clinical experience in the diagnosis and treatment of the disease is lacking. CASE SUMMARY The patient was a 75-year-old woman who had experienced recurrent chills with nausea and vomiting for 3 mo. Computed tomography, magnetic resonance imaging, endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography led to the diagnosis of malignant tumor of the CBD. The patient ultimately underwent cholecystectomy, CBD resection, and choledochojejunostomy. Postoperative pathological examination revealed carcinosarcoma of the CBD, and the latest follow-up showed that the patient is recovering well. Based on previous case reports, some carcinosarcoma has ossification characteristics in imaging. If it is misdiagnosed as biliary calculi, the use of laser lithotripsy in surgery may lead to tumor diffusion. Choledochoscopy and narrow band staining of mucosa are very important for diagnosis. CONCLUSION We herein present a rare case of carcinosarcomas of the CBD, we found the tumours may have imaging features of polypoid growth and ossification only when the sarcomal components are bone differentiation, while show soft tissue shadow when non bone differentiation. Confirmation of diagnosis depends greatly upon postoperative pathological examination and the adjuvant treatment has not been established, which leads to the poor prognosis.

Sarcomatoid carcinoma of the common bile duct presenting as painless jaundice

“…Literature surrounding sarcomatoid carcinomas of the CBD is very limited—there have been 13 case reports published 11. Reported cases suggest that incidence is similar between men and women, and that the majority occur in the elderly 11.…”

“…Literature surrounding sarcomatoid carcinomas of the CBD is very limited—there have been 13 case reports published 11. Reported cases suggest that incidence is similar between men and women, and that the majority occur in the elderly 11. Clinical manifestations at the time of presentation include obstructive jaundice, cholangitis, abdominal pain, weight loss and fatigue 12.…”

“…Most cases are located in either the mid or distal CBD, with a minority located in the hilum 13. The underlying pathophysiology is unclear but there are numerous theories as to how they develop including collision, combination, conversion, composition, and the epithelial to mesenchymal transition pathway 11…”