Ann Liver Transplant.  2022 May;2(1):95-101. 10.52604/alt.22.0007.

Pancreaticoduodenectomy for recurrence of intraductal papillary neoplasm of bile duct at seven years after curative resection

• Oh SY
• Hwang S
• Kim Y
• Jwa EK

• KMID: 2560887
• DOI: http://doi.org/10.52604/alt.22.0007

Abstract

Intraductal papillary neoplasm of bile duct (IPNB) is a rare variant of bile duct tumor with a wide range of histology from low-grade dysplasia to invasive carcinoma. A high-grade IPNB can be regarded as a malignant lesion because of potential tumor recurrence after curative resection. We herein report a case of IPNB recurrence at seven years after curative resection of IPNB with a high-grade dysplasia. A 63-yearold male patient underwent right anterior sectionectomy for IPNB with a high-grade dysplasia after close observation for four years. Postoperatively, recurrent IPNB lesion in the distal bile duct was diagnosed at postoperative seven years. Because the mass was localized without metastasis, pylorus-preserving pancreaticoduodenectomy was performed for the recurrent IPNB. The patient recovered uneventfully without specific complications. He has been doing well for one year without any evidence of recurrence. The recurrent IPNB lesion was a low-grade dysplasia, which was slightly different from the initial IPNB. Immunohistochemical status of MUC1/MUC2 stain was identical, indicating that the IPNB at the distal common bile duct was a recurrent lesion of the initial intrahepatic IPNB. The present case indicates that long-term follow-up is necessary for patients after undergoing curative resection for IPNB of low- or high-grade dysplasia, although the risk of tumor recurrence is not high. Aggressive surgical treatment for recurrent IPNB lesion is a viable option to achieve long-term survival after prudent consideration of postoperative recurrence pattern.

Keyword

Intraductal papillary neoplasm of bile duct; Recurrence; Dysplasia; Hepatectomy; Pancreaticoduodenectomy