A Case of Intracholecystic Papillary Neoplasm with Early Recurrence of Liver Metastases after Curative Resection

Abstract

A 61-year-old woman underwent screening upper endoscopy for anemia, which showed an extrinsic compression at the antrum of the stomach. Contrast-enhanced CT (CE-CT) showed a solid lesion with abundant blood flow occupying the gallbladder. Apparent serosal invasion or liver infiltration was not observed. Elective surgery was scheduled due to suspected gallbladder cancer, but she developed cholecystitis while waiting for surgery. She underwent emergent open extended cholecystectomy and hilar lymph node dissection. The microscopic examination revealed high-grade intracholecystic papillary neoplasm (ICPN) with massive hemorrhagic necrosis. Since there was neither tumor infiltration at the cystic duct stump nor lymph node metastasis, no additional resection or adjuvant chemotherapy was performed. Four months after the operation, CE-CT for abdominal pain showed multiple liver metastases with intratumoral hemorrhage. Transcatheter arterial embolization (TAE) stabilized her condition, and she was discharged from the hospital. One month after TAE, however, she again developed abdominal pain. On CE-CT, multiple liver metastases had rapidly increased, and intratumoral hemorrhage was noted again. Tumor bleeding was stopped with TAE, but one month later (six months after surgery), she died of cancer.