Unexpected metastasis of intraductal papillary neoplasm of the bile duct without an invasive component to the brain and lungs: A case report

Figure 5 Variation in the CA 19-9 level in correlation with clinical events. Time A (2015 December): Diagnosis of intraductal papillary neoplasm of the bile duct T1N0M0; Time B (2016 January): Good prognosis with satisfactory postoperative pathological findings, such as high-grade intraepithelial neoplasia pattern without an invasive component, R0 resection, no extended metastasis, lymph node (-) and ascites cytology (-); Time C (2018 September): Detection of suspected metastatic adenocarcinoma of bile duct origin with a 26 mm lung tumor, a 12 mm brain tumor and a 4-fold higher level of CA 19-9; Time D (2018 November): VATS lobectomy and SRT for brain tumor; and Time E (2019 January): Stable condition with normal level of CA 19-9.