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Bilateral ovarian metastasis from distal common bile duct carcinoma developing after choledochal cyst excision.

Lee SE, Choi YS, Kim MK, Oh HC, Do JH - Korean J Hepatobiliary Pancreat Surg (2015)

Bottom Line: Pylorus-preserving pancreatoduodenectomy and bilateral salphingo-oophorectomy with hysterectomy were performed.Both ovarian masses were consistent with metastatic adenocarcinoma from the common bile duct.The patient received six cycles of postoperative adjuvant systemic chemotherapy, dying after 10 months due to pulmonary embolism.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea.

ABSTRACT
Ovarian metastases represent about 3-5% of all ovarian malignancies. Most of these tumors originate in the digestive tract and cholangiocarcinoma rarely involves the ovary. A 60-year-old woman was admitted for the investigation of abdominal distension that had lasted 1 week. One and a half years prior, the patient had undergone choledochal cyst excision, Roux-en Y hepaticojejunostomy and cholecystectomy. Computed tomography scans of the abdomen revealed a papillary mass in the remnant distal common bile duct and enlargement of both ovaries with a huge amount of ascites. An explorative laparotomy disclosed no peritoneal seeding with resectable cholangiocarcinoma and bilateral ovarian mass. Pylorus-preserving pancreatoduodenectomy and bilateral salphingo-oophorectomy with hysterectomy were performed. Histologically, it was a well-differentiated adenocarcinoma and all surgical margins were free of tumor. Both ovarian masses were consistent with metastatic adenocarcinoma from the common bile duct. The patient received six cycles of postoperative adjuvant systemic chemotherapy, dying after 10 months due to pulmonary embolism.

No MeSH data available.


Related in: MedlinePlus

Computed tomography scan showing papillary mass in the remnant distal common bile duct (arrow).
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Figure 1: Computed tomography scan showing papillary mass in the remnant distal common bile duct (arrow).

Mentions: A 60-year-old woman was admitted for the investigation of abdominal distension that had lasted for 1 week. One and a half years prior, the patient had been diagnosed with a choledochal cyst and had undergone choledochal cyst excision, Roux-en Y hepaticojejunostomy and cholecystectomy at another hospital. Histopathologic findings from that time showed no evidence of malignancy of choledochal cyst. On physical examination, her abdomen was soft and distended severely without a palpable mass. Laboratory evaluation revealed elevation levels of alkaline phosphatase (415 U/L, normal range 50-200 U/L) and CA 19-9 (2,409 U/L, normal range <37 U/L). Computed tomography scan and magnetic resonance cholangiopancreatography revealed a papillary mass in the remnant distal common bile duct (CBD) (Fig. 1), bilateral enlargement of ovaries with huge amount of ascites (Fig. 2) and no other metastatic lesion. An explorative laparotomy disclosed no peritoneal seeding with resectable cholangiocarcinoma, bilateral ovarian masses measuring about 10 cm with irregular surface, multilobular cut surface and solid texture and ascites totaling about 1,000 ml. She underwent a pylorus preserving pancreaticoduodenectomy and bilateral salphingo-oophorectomy with hysterectomy. Cross sections of the excised specimen showed CBD dilated to 5 cm in the pancreatic head and papillary mass was seen inside of it. Histologically, it was a well-differentiated adenocarcinoma, which extended to the pancreas with perineural invasion and regional lymph node metastasis. All surgical margins were free of tumor. Both ovarian masses were consistent with metastatic adenocarcinoma from CBD. The post-operative course was uneventful. The patient received six cycles of postoperative palliative adjuvant systemic chemotherapy with 5-fluorouracil and cisplatin. After finishing 6 cycles of 5-fluorouracil-based chemotherapy, severe ascites redeveloped without definite metastatic lesion and with negative cytology. The patient expired at approximately 10 months postoperatively due to pulmonary embolism.


Bilateral ovarian metastasis from distal common bile duct carcinoma developing after choledochal cyst excision.

Lee SE, Choi YS, Kim MK, Oh HC, Do JH - Korean J Hepatobiliary Pancreat Surg (2015)

Computed tomography scan showing papillary mass in the remnant distal common bile duct (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494081&req=5

Figure 1: Computed tomography scan showing papillary mass in the remnant distal common bile duct (arrow).
Mentions: A 60-year-old woman was admitted for the investigation of abdominal distension that had lasted for 1 week. One and a half years prior, the patient had been diagnosed with a choledochal cyst and had undergone choledochal cyst excision, Roux-en Y hepaticojejunostomy and cholecystectomy at another hospital. Histopathologic findings from that time showed no evidence of malignancy of choledochal cyst. On physical examination, her abdomen was soft and distended severely without a palpable mass. Laboratory evaluation revealed elevation levels of alkaline phosphatase (415 U/L, normal range 50-200 U/L) and CA 19-9 (2,409 U/L, normal range <37 U/L). Computed tomography scan and magnetic resonance cholangiopancreatography revealed a papillary mass in the remnant distal common bile duct (CBD) (Fig. 1), bilateral enlargement of ovaries with huge amount of ascites (Fig. 2) and no other metastatic lesion. An explorative laparotomy disclosed no peritoneal seeding with resectable cholangiocarcinoma, bilateral ovarian masses measuring about 10 cm with irregular surface, multilobular cut surface and solid texture and ascites totaling about 1,000 ml. She underwent a pylorus preserving pancreaticoduodenectomy and bilateral salphingo-oophorectomy with hysterectomy. Cross sections of the excised specimen showed CBD dilated to 5 cm in the pancreatic head and papillary mass was seen inside of it. Histologically, it was a well-differentiated adenocarcinoma, which extended to the pancreas with perineural invasion and regional lymph node metastasis. All surgical margins were free of tumor. Both ovarian masses were consistent with metastatic adenocarcinoma from CBD. The post-operative course was uneventful. The patient received six cycles of postoperative palliative adjuvant systemic chemotherapy with 5-fluorouracil and cisplatin. After finishing 6 cycles of 5-fluorouracil-based chemotherapy, severe ascites redeveloped without definite metastatic lesion and with negative cytology. The patient expired at approximately 10 months postoperatively due to pulmonary embolism.

Bottom Line: Pylorus-preserving pancreatoduodenectomy and bilateral salphingo-oophorectomy with hysterectomy were performed.Both ovarian masses were consistent with metastatic adenocarcinoma from the common bile duct.The patient received six cycles of postoperative adjuvant systemic chemotherapy, dying after 10 months due to pulmonary embolism.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea.

ABSTRACT
Ovarian metastases represent about 3-5% of all ovarian malignancies. Most of these tumors originate in the digestive tract and cholangiocarcinoma rarely involves the ovary. A 60-year-old woman was admitted for the investigation of abdominal distension that had lasted 1 week. One and a half years prior, the patient had undergone choledochal cyst excision, Roux-en Y hepaticojejunostomy and cholecystectomy. Computed tomography scans of the abdomen revealed a papillary mass in the remnant distal common bile duct and enlargement of both ovaries with a huge amount of ascites. An explorative laparotomy disclosed no peritoneal seeding with resectable cholangiocarcinoma and bilateral ovarian mass. Pylorus-preserving pancreatoduodenectomy and bilateral salphingo-oophorectomy with hysterectomy were performed. Histologically, it was a well-differentiated adenocarcinoma and all surgical margins were free of tumor. Both ovarian masses were consistent with metastatic adenocarcinoma from the common bile duct. The patient received six cycles of postoperative adjuvant systemic chemotherapy, dying after 10 months due to pulmonary embolism.

No MeSH data available.


Related in: MedlinePlus