A case of intraductal papillary neoplasm of the bile duct recurred at the remnant lower bile duct after curative liver resection

Abstract

A 68-year-old man underwent right hepatectomy with caudate lobectomy and extrahepatic bile duct resection under the preoperative diagnosis of intrahepatic cholangiocarcinoma in August 2011. Histologically the tumor was well differentiated adenocarcinoma with mucin production and diagnosed with intraductal papillary neoplasm of the bile duct (IPNB) with an associated invasive adenocarcinoma. The bile duct margins were negative for cancer. Sixteen months later, another tumor was found at the dilated remnant lower bile duct on abdominal CT scanning. He underwent pancreatoduodenectomy with the preoperative diagnosis of carcinoma of the lower bile duct or ampulla of Vater. Histologically the tumor was invasive papillary adenocarcinoma similar to the first resected tumor. It is generally expected that prognosis after curative resection for IPNB is good, but our case suggests that this tumor has the potential for recurrence at the remnant bile duct. Therefore, surgeons should follow up the patients carefully even after curative operation for IPNB.