中部胆管癌切除後PTBD瘻孔部再発の1例

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  • A CASE OF METASTATIC SEEDING AT THE PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE SINUS TRACT FOR A DISTAL BILE DUCT CANCER

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Although metastatic seeding to the percutaneous transhepatic biliary (PTBD) sinus tract is a probable mode of metastasis after curative resection of biliary cancer, there have been few cases of the disease which was successfully resected. We present a case of curative resection for this type recurrencewith a review of the literature in Japan. A 75-year-old man with a distal bile duct carcinoma underwent a pylorus preserving pancreatoduodenectomy 40 days after PTBD for obstructive jaundice. Macroscopically, it was a nodular tumor at the distal bile duct. Microscopically, the tumor was moderately differentiated tubular adenocarcinoma invading subserosal layer and without nodal invasion. Seven months after the surgery, abdominal CT and US revealed a low density mass in the abdominal wall and the liver surface just blow the PTBD scar with a slight elevation of serum CA 19-9 level. This mass was diagnosed as a metastatic seeding at the PTBD sinus tract. A resection of the abdominal wall and a left lateral superior subsegmentectomy of the liver were performed. Re-sected specimen demonstrated a metastatic adenocarcinoma invading the abdominal muscle and liver. As of 6 months after the second surgery, the patient is in good health without any evidence of tumor recurrence. Caution should be paid for metastatic seeding at the PTBD sinus tract after surgery for biliary cancer.

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