A Case of Postoperative Bile Duct Carcinoma with Resection of Bilateral Pulmonary Metastases

Abstract

The patient was a 64-year-old woman who underwent pancreatoduodenectomy for lower bile duct carcinoma (tubular adenocarcinoma, moderately differentiated, pT2N2M0 Stage III) four years previously. A follow-up chest CT scan showed a nodular shadow in the right S8, a nodular shadow in the left S9, and a trabecular shadow in the left S3. No other mass lesions were found. Wedge resection of the right lung tumor, suspected to be pulmonary metastasis or primary lung cancer, was performed. Histology showed adenocarcinoma with mucin secretion, similar to the histology of the lower bile duct carcinoma. Immunohistochemistry revealed the neoplasm to be negative for SP-A, TTF-1 and Napsin A. Based on the histopathological findings, we diagnosed the tumor as pulmonary metastasis. Two months after the resection of the right lung tumor, two left lung tumors were resected. The tumors showed the same histopathological features as the tumor in the right lung. Until now, 2 years since the resection of the left lung tumors, no recurrence has been detected. Treatment for pulmonary metastases from bile duct carcinoma is not yet established. In our case, the pulmonary metastases affected the bilateral lungs, however, we considered that surgery would be feasible and resection was successfully performed.