Images in Clinical Medicine
Kim Eagle, M.D., Editor
A Metastasis Caught in the Act
N Engl J Med 1996; 335:1733December 5, 1996
- Article
Figure 1 A 52-year-old man with no history of serious illness presented with abdominal pain, dark-colored urine, light-colored stools, and jaundice. Abdominal ultrasonography revealed dilatation of the intrahepatic and extrahepatic bile ducts. Surgical exploration and a pancreatoduodenectomy (Whipple's resection) were performed, revealing an infiltrating, poorly differentiated adenocarcinoma of the distal common bile duct. The carcinoma measured 2.0 cm in its greatest dimension. All margins of resection were negative for tumor. Fifteen lymph nodes were examined histologically for evidence of metastasis, and a single micrometastasis was identified (arrow). The carcinoma is present in sinusoids within the node and in a dilated lymphatic leading into the node (hematoxylin and eosin, ×62.5). The patient recovered uneventfully and was sent home on the 10th postoperative day. Two months after surgery, he began a course of radiation therapy and fluorouracil-based chemotherapy. At the most recent follow-up visit, he had no evidence of recurrence.
Kim Eagle, M.D.
Daniel J. Brat, M.D., Ph.D.
Ralph H. Hruban, M.D.
Johns Hopkins Hospital, Baltimore, MD 21287
