A case of distal bile duct carcinoma with PTBD catheter tract metastasis followed by abdominal wall recurrence

Abstract

A 79-year-old man presented with dark urine. Laboratory tests revealed obstructive jaundice and hepatic dysfunction. Distal bile duct carcinoma was diagnosed based on findings of abdominal CT and MRCP. The jaundice improved after PTBD. He underwent pancreatoduodenectomy and local excision of the abdominal wall with the PTBD catheter tract. The histological examination revealed implantation of cancer cells in the catheter tract. He underwent adjuvant chemotherapy with S-1. 18 months after the operation, a tumor was found in the abdominal wall near the site of catheter tract. Aspiration cytology confirmed a recurrence of bile duct carcinoma. 24 months after the operation, follow-up CT showed multiple liver metastases. He underwent systemic chemotherapy with gemcitabine combined with S-1, followed by transcatheter arterial chemoembolization for the liver metastases and local radiation therapy for the abdominal wall tumor. At 32-month follow up, the patient was alive and well. It is suggested that the patients with implantation of bile duct carcinoma in the PTBD catheter tract have a possibility of metachronal peritoneal seeding. Careful observation should be considered for the patients with catheter tract metastasis.