Local recurrence at hepaticojejunostomy 9 years after resection of bile duct cancer with superficial flat spread

Abstract

We report a male patient aged 45 years, who in 1993 had been diagnosed as having middle bile duct cancer and had received a pancreatoduodenectomy. Histopathology showed a nodular tumor with the main lesion in the middle bile duct and superficial spreading in both proximal and distal directions (which was not observed macroscopically), and residual tumor in the epithelium of the cut edge near the liver. The patient underwent follow-up without postoperative adjuvant therapy. In 2002, 9 years after the operation, the patient developed jaundice and was diagnosed with recurrence of bile duct cancer in the anastomotic site, based on cholangiographic results. He underwent resection of the right hepatic and caudate lobes and the anastomotic region of the bile duct and jejunum. Pathological findings showed an invasive tumor in the anastomotic region, with continuous intraepithelial spread in the direction of the bile duct, which suggested that the residual tumor in the epithelium had grown to become an invasive cancer. In this patient, the recurrence required 9 years after resection. This case provides evidence for the clinical course that might be anticipated for a patient with a residual tumor in the epithelium of the bile duct stump and subsequent superficial spreading bile duct cancer.

Characteristics of Bile Duct Carcinoma with Superficial Extension in the Epithelium

“…Carcinomas with SE showed no portal infiltration and less lymph node metastasis compared to those without SE, which may indicate the potential for lower cases of local recurrence with a long disease-free period by follow-up after initial resection. Growth seems slow in carcinomas with SE and, although care must be taken regarding tumor recurrence for a long period of >10 years (22,23). At this stage, extensive curative resection was necessary for BDCs either with SE or without SE regardless of poorer prognostic influences, as surgical resection was the only hope for long-term survival in BDC patients (2).…”

Surgical management of carcinoma in situ at ductal resection margins in patients with extrahepatic cholangiocarcinoma

“…Several research groups reported that survival following resection was comparable between patients who had negative ductal margins (median survival time, 33‐55 months) and those who had positive ductal margins with carcinoma in situ (median survival time, 37‐99 months) 26, 27, 28, 31, 32, 35. Although residual carcinoma in situ at the ductal margins does not have a strong adverse effect on survival in patients with extrahepatic cholangiocarcinoma, it may result in late local recurrence 26, 27, 28, 29, 31, 32, 34, 36, 53, 54, 55, 56, 57…”

Extrahepatic bile duct carcinoma with extensive intraepithelial spread: a clinicopathological study of 21 cases

“…In addition, we also reported two cases of late recurrence of extrahepatic bile duct carcinoma with intraepithelial spread after surgery. 4,5 However, the clinicopathological characteristics of extrahepatic bile duct carcinoma with intraepithelial spread have been barely reported. It has not been revealed whether or not intraepithelial-spreading bile duct carcinoma has unique pathological characteristics or intraepithelial spread impacts postoperative survival.…”