A super-elderly patient with distal biliary tract cancer and tumor-associated granuloma: a case report.

Background: Distal cholangiocarcinoma (dCCA) has a poor prognosis, and radical surgery is the only potential curative approach. However, elderly patients (≥80 years old) are often excluded from surgery due to high perioperative risks, and related reports are rare. Case presentation: This article reports a 90-year-old female patient who presented with upper abdominal pain and distension. Imaging studies suggested a mass in the head of the pancreas. After undergoing pancreaticoduodenectomy, the pathology confirmed poorly differentiated cholangiocarcinoma, with negative margins (R0 resection). Notably, no cancer metastasis was found in the regional lymph nodes, but non-caseating granulomas were observed, which were considered to be tumor-related granulomatous reactions. Treatment and outcomes: The patient received meticulous volume management, anti-infection, and supportive treatment after surgery and was discharged in good condition. Postoperatively, she experienced transient cardiac function stress and secondary fungal infection, which were controlled after symptomatic treatment. Conclusion: This case indicates that age should not be an absolute contraindication for radical surgery in elderly dCCA patients with acceptable physical conditions after strict evaluation. Through precise surgery and multidisciplinary perioperative management, safe resection and survival benefits can be achieved. At the same time, clinicians need to be vigilant about this rare phenomenon of tumor-related granulomatous reactions and incorporate it into the differential diagnosis and follow-up system.