Postoperative Dissemination of Early-stage Perihilar Cholangiocarcinoma to Skin of Surgical Scar with Metachronous Cancer of the Papilla of Vater

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  • Stage Ⅰ肝門部領域胆管癌術後にドレーン瘻孔播種再発とVater乳頭部癌発症をきたした１例

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<p>A 76-year-old Japanese woman underwent endoscopic retrograde cholangiopancreatography to investigate high serum levels of CA19-9, and common bile duct cancer (BDC) was diagnosed. We performed choledochectomy, and well-differentiated tubular adenocarcinoma limited to the mucous membrane (well-tub) with no lymph node metastasis or vessel infiltration was pathologically diagnosed. Surveillance 22 months after choledochectomy revealed well-tub of the papilla of Vater limited to the mucous membrane, and pancreatoduodenectomy was performed. Both well-tub were morphologically similar, and showed positive staining for CDX2, CK7, and CK19, and negative immunohistochemical staining for CK20. A skin tumor 2cm in diameter on the surgical scar developed 5 months after pancreaticoduodenectomy, and biopsy revealed well-tub. We diagnosed metachronous double cancer of the bile duct and papilla of Vater, and skin metastasis. This suggests that intraoperative sprays of bile juice can cause intraoperative and fistulous dissemination. The patient died due to intraabdominal dissemination 29 months after the first operation. Both double early-stage cancers involving the bile duct and papilla of Vater, and early dissemination of BDC are rare. This, however, suggests that BDC in the early stage could disseminate to other sites. Clinicians should bear this potential for dissemination in mind, and plan imaging studies for bile duct tumors carefully.</p>

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