Obstructive Jaundice due to Metastasis from Pulmonary Adenocarcinoma to Distal Common Bile Duct

Abstract

A 63-year-old woman presented with obstructive jaundice. Patient was diagnosed as stage III lung adenocarcinoma 3 years ago, and underwent surgery and concurrent chemoradiotherapy. Immunostaining revealed positivity for thyroid transcription factor-1 (TTF-1) and cytokeratin (CK) 7, and negativity for CK20. Fluorescent in situ hybridization test revealed tyrosine kinase inhibitor (ALK) gene rearrangement. However, right buccal metastasis with no other metastasis was found, and she had been followed up with palliative radiotherapy. Laboratory tests showed elevated total bilirubin (9.9 mg/dL [reference value, 0.2-1.2 mg/dL]). Abdominal computed tomography (CT) showed 2.4 cm ill-defined mass with abrupt narrowing at distal common bile duct (CBD) (Fig. 1A,