부산대학교 도서관

Recently, intraductal ultrasonography (IDUS) is widely used in preoperative diagnosis of malignancy in pancreatobiliary system. Here we report a case of early bile duct cancer with extend to the papilla of Vater, which precisely diagnosed by EUS and IDUS. The patient was admitted to our hospital with mild abnormality of liver function tests and with slight dilatation of extrahepatic bile duct on US. ERC disclosed a stricture at distal bile duct (Bi) and IDUS, intra-pancreatic duct scanning, show polypoid lesion in Bi. IDUS via percutaneous transhepatic route demonstrate the lubulated mass lesion in Bi which extend to intrapapillary bile duct (Ab). A locarized hypoechoic thickening of bile duct stick to the mass lesion was also detected, which considered to be reflect the subserosal invasion. EUS showed the mass lesion as irregular thickening of inner layer of bile duct without abnormality of outer hyperechoic layer of bile duct wall and muscular layer of duodenum. Pancreatoduodenectomy was performed, and histological findings of resected specimen disclosed a well differentiated bile duct cancer locused on Bi and Ab. The depth of invasion was within fibromuscular layer, and subserosal fibrosis at most deep site was also shown.