ADENOCARCINOMA OF THE COMMON BILE DUCT
This 78 year old male presented with a story of fever of sudden onset 17 days previously, associated with rigors, shivers and sweats. His urine was dark and his bowel motions clay coloured. There was no story of fat intolerance, weight loss or pain. There was a past history of tropical disease, including malaria more than thirty years ago. On examination, the patient was jaundiced, with a temperature of 38.4_C, pulse rate 100 and regular blood pressure 100/60. Four finger breadths of tender liver were palpable and there was an oval mass in the right hypochondrium. There was a steady deterioration with the development of a bleeding tendency and eventually death.
The specimen is a gall bladder, 12 cm in length and 5 cm in circumference, in continuity with cystic duct, the distal portion of the biliary drainage system and a small portion of the head of the pancreas. The gall bladder and ducts have been opened to display the mucosal surface. The gall bladder is dilated. The wall is thin and the mucosa appears normal. The cystic duct is slightly dilated (circumference 10 mm). There is gross dilatation of the common hepatic duct and proximal 5 cm of the common bile duct which measure up to 4.5 cm in circumference. In the common bile duct 5 cm distal to the origin of the cystic duct there is a tumour which has occluded the common bile duct and caused the marked dilatation seen proximal to the obstruction. The tumour is 1.0 x 0.5 cm in diameter, and is composed of firm brown tissue with patchy pale areas. The tumour has infiltrated through the wall of the common bile duct which at this point is closely applied to the head of the pancreas. This is a case of adenocarcinoma of the common bile duct causing complete biliary obstruction, leading to liver failure and death.