Fig. 1Abdominal computed tomography and cholangiogram. (A) Coronal image of abdominal computed tomography shows complete obstruction of the bile duct due to the thickening of the bile duct wall (arrow). (B) Endoscopic retrograde cholangiogram shows complete obstruction at the distal common bile duct.
Fig. 2Macroscopic and microscopic findings of the tumor at the distal common bile duct. (A) An ulcerofungating tumor identified at the distal common bile duct (arrow). (B) Carcinoma invaded into the capsule of the pancreas. At high-power field, microscopic examination of the tumor reveal a signet-ring cell carcinoma comprising more than 50% of the tumor tissue (C), and a few perineural invasion are present (D, arrow).
Table 1.Summary of four cases of signet-ring cell carcinoma of the extrahepatic bile duct
Case No. |
Age/Sex |
Race |
Chief complaint |
CT findings |
Treatment |
Notable microscopic findings |
Pathologic staging |
Follow-up |
Reference |
1 |
78/F |
Japanese |
Not described |
Bile duct thickening and stenosis |
Not described (biopsy and scratch only) |
Not described |
No described |
Not described |
Hiraki et al. [5] (2007) |
2 |
23/M |
Japanese |
Jaundice |
Bile duct stricture, proximal bile duct dilatation |
PPPD |
Portal vein wall invasion |
T4N1M0 |
No recurrence, for 6 mo |
Ogata et al. [6] (2010) |
3 |
55/M |
Korean |
Jaundice, pruritus |
Hypervascular mass |
PPPD with chemoradiotherapy |
Neural invasion, mucin pool formation |
T3N1M0 |
No recurrence, for 2 yr |
Lee et al. [7] (2010) |
4 |
63/M |
Korean |
Epigastric pain, jaundice |
Bile duct thickening and narrowing, proximal bile duct dilatation |
PPPD |
Neural invasion, lymphatic emboli |
T3N0M0 |
Expired, 15 mo later |
Present case |