The cystic duct has been included in the staging classification scheme for gallbladder cancer since the 2010 publication of the AJCC Cancer Staging Manual (7th edition). To our knowledge, only seven other cases of adenocarcinoma arising in the remnant cystic duct following cholecystectomy have been reported in the English-language literature, and none has been reported as primary early-stage T1b remnant cystic duct cancer (CDC). We report, herein, a case of primary adenocarcinoma arising in the remnant cystic duct in a patient with history of laparoscopic cholecystectomy for gallstone disease. An 81-year-old female presented with abdominal pain. Her medical history included a laparoscopic cholecystectomy for cholecystolithiasis two years prior. Jaundice was observed; imaging studies suggested that this was caused by choledocholithiasis. Blood chemistry findings showed severe liver dysfunction. Endoscopic retrograde cholangiography revealed haemobilia from the common bile duct with no evidence of choledocholithiasis. A bile sample showed Papanicolaou class IV cytology. As the extent of tumour spread was undetermined by abdominal ultrasonography and endoscopic ultrasonography, peroral cholangioscopy (POCS) was performed, which revealed tiny papillary lesions within the confluence of cystic duct, and fine granular lesions in the centre of bile ducts, signifying early-stage remnant CDC. Extrahepatic bile duct resection with regional lymphadenectomy was done. Histopathological findings revealed a 42-mm tubular adenocarcinoma originating from the remnant cystic duct with the considerable shallow spread across the extrahepatic bile ducts. It invaded the fibromuscular layer, with no lymphovascular or perineural invasion, no lymph node metastasis (13 nodes examined), and uninvolved surgical resection margin (R0 resection), and was staged as pT1bN0M0, Stage I. Primary early-stage T1b remnant CDC is an uncommon condition for which early diagnosis is challenging; if intraoperatively recognized, it can complicate surgery. Our experience of this case and an overview of the English literature suggest that POCS is an efficient tool to diagnosis this tumour and assess its spread along the extrahepatic bile ducts.

中文翻译：

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腹腔镜胆囊切除术后残余胆囊管中发生的早期T1b腺癌：一例报告并文献复习

自2010年AJCC癌症分期手册（第7版）发布以来，胆囊癌已被包括在胆囊癌分期分类方案中。据我们所知，英语文献中仅报道了另外7例在胆囊切除术后残留的胆囊管中发生的腺癌，没有报道为原发性早期T1b残留胆囊管癌（CDC）。我们在这里报告了腹腔镜胆囊切除术的胆囊结石病史的患者在残留的胆囊管中发生的原发性腺癌的病例。一位81岁的女性出现腹痛。她的病史包括两年前腹腔镜胆囊切除术治疗胆囊结石症。观察到黄疸；影像学研究表明，这是由胆总管结石引起的。血液化学检查结果显示严重肝功能异常。内镜逆行胆管造影显示胆总管出血，没有胆总管结石的迹象。胆汁样本显示Papanicolaou IV类细胞学。由于腹部超声和内窥镜超声无法确定肿瘤的扩散程度，因此进行了经口胆管镜检查（POCS），发现胆囊管汇合处有微小的乳头状病变，胆管中心有细小颗粒状病变，表明早期剩余的CDC。进行肝外胆管切除并局部淋巴结清扫术。组织病理学发现显示42mm的管状腺癌起源于残余的胆囊管，并在肝外胆管中有相当浅的扩散。它侵入了纤维肌层，无淋巴管或神经周围浸润，无淋巴结转移（检查了13个结点），且未进行手术切除切缘（R0切除），分期为pT1bN0M0，I期。原发性早期T1b残留CDC是罕见的，早期诊断具有挑战性；如果术中认识到，可能会使手术复杂化。我们对该病例的经验以及对英国文献的概述表明，POCS是诊断该肿瘤并评估其沿肝外胆管扩散的有效工具。它会使手术复杂化。我们对该病例的经验以及对英国文献的概述表明，POCS是诊断该肿瘤并评估其沿肝外胆管扩散的有效工具。它会使手术复杂化。我们对该病例的经验以及对英国文献的概述表明，POCS是诊断该肿瘤并评估其沿肝外胆管扩散的有效工具。