[A Slight Change of Cholangiography Revealed Papillary Carcinoma of the Duodenum after Endoscopic Sphincterotomy(EST)].

A 79-year-old woman with chillness and nausea was admitted to our hospital. CT findings displayed a common extended bile duct with stacked stones and duodenal diverticulosis. The diagnosis was cholangitis with choledocholithiasis. She underwent endoscopic retrograde cholangiopancreatography(ERCP)to remove the common bile duct stones. Thereafter, she developed cholangitis several times without any obvious cause of biliary obstruction. A careful follow-up was continued using ERCP, and finally, a slightly irregular edge of the distal common bile duct was observed. Subsequently, bile duct brush cytology revealed adenocarcinoma. The final diagnosis was distal cholangiocarcinoma. An operation was performed and the pathological diagnosis of papillary carcinoma of the duodenum invading the common bile duct was made. We reviewed the first ERCP image findings retrospectively and noticed an abnormal papillary of the duodenum. We could not evaluate the papilla after endoscopic sphincterotomy(EST). We learned 2 important things. The first is to carefully observe naïve papilla, and the second is to pay attention to a slight change of cholangiography.

[A Case of Micropapillary Carcinoma in the Sigmoid Colon].

In Japan, the number of the patients with colorectal carcinomas is increasing. Micropapillary carcinoma(MPC)is a rare adenocarcinoma that shows a characteristic histological feature. The first case of MPC was reported in 1993, which originated in the breast. It has been reported that MPC also rarely arises in the colon. In this report, we showed a case of MPC arising in the sigmoid colon in a 73-year-old man with adenosquamous carcinoma in the lung. The patient consulted a home physician due to cough, and a tumor on the right lung of the patient was detected by chest radiography and CT. The lung tumor was histologically diagnosed as adenosquamous carcinoma. FDG-PET/CT revealed hot spots in not only the right lung but also the sigmoid colon. Carcinoma was detected in the sigmoid colon through a colorectal endoscopic examination, and the carcinoma with regional lymph node metastasis was resected. The histological examination of the colon carcinoma revealed that it was MPC without any other histological types and with marked metastasis to the lymph nodes. For the treatment of lung cancer, additional treatment for colon cancer was not performed. Since pure MPC arising in the colon is extremely rare, the patient is followed carefully.

[A case of obstructive jaundice caused by MALT lymphoma of the common bile duct and the papilla of Vater].

We report a rare case of mucosa-associated lymphoid tissue (MALT) lymphoma of the common bile duct and the papilla of Vater. A 66-year-old man was admitted to our hospital with right upper quadrant pain and jaundice. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography showed common bile duct stenosis. Further endoscopy revealed swelling of the papilla of Vater, with erosion at the ileal end. The patient was pathologically diagnosed with MALT lymphoma and treated for Helicobacter pylori eradication, after which the lesions improved. However, 1 year later, the lesions began to enlarge again;thus, he was treated with 6 courses of combination chemotherapy (R-CHOP). After treatment, the tumor and erosion of the papilla of Vater disappeared and the stenosis of the common bile duct improved.