Intraductal Papillary Neoplasm of the Bile Duct Asynchronously Recurred at the Remnant Bile Duct 3 Years after Operation for Hilar Cholangiocarcinoma

Abstract

We report a case of an 81-year-old man who had undergone hemihepatectomy with caudate lobectomy for hilar cholangiocarcinoma at 77 years of age. The pathological diagnosis was papillary adenocarcinoma; the ductal margin was tumor-free. CT performed 3 years after surgery showed a papillary tumor in the remnant bile duct of the pancreas. A tumor biopsy revealed a well-differentiated adenocarcinoma. Following pancreatoduodenectomy, the tumor was diagnosed as a high-grade papillary adenocarcinoma, pTis, med, ly0, v0, ne0, Stage 0, without invasion; further, based on the WHO 2010 classification, it was diagnosed as a pancreatobiliary-type intraductal papillary neoplasm of the bile duct (IPNB). Re-examination of tissue specimens from the original hilar cholangiocarcinoma revealed that both original and recurrent tumors shared similar histopathological characteristics of IPNB. Generally, the curative resection of IPNB has a good prognosis; however, the present case shows that recurrence may occur at the remnant bile duct. Patients with IPNB should be followed-up closely after resection. Subsequent surgical procedures can be performed if the patient’s general condition is good.