Xiao G, Xia T, Mou YP, Zhou YC. Reoperation for heterochronic intraductal papillary mucinous neoplasm of the pancreas after bile duct neoplasm resection: A case report. World J Gastrointest Surg 2023; 15(7): 1542-1548 [PMID: 37555129 DOI: 10.4240/wjgs.v15.i7.1542]
Corresponding Author of This Article
Yi-Ping Mou, MD, Chief & Chairman, Division of Gastrointestinal and Pancreatic Surgery, Department of General Surgery, Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College), Key Laboratory of Gastroenterology of Zhejiang Province, No. 158 Shangtang Road, Gongshu District, Hangzhou 310014, Zhejiang Province, China. yipingmou@126.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1542-1548 Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1542
Reoperation for heterochronic intraductal papillary mucinous neoplasm of the pancreas after bile duct neoplasm resection: A case report
Gang Xiao, Tao Xia, Yi-Ping Mou, Yu-Cheng Zhou
Gang Xiao, Department of Hepatopancreatobiliary Surgery, Shaoxing People’s Hospital, Shaoxing 312000, Zhejiang Province, China
Tao Xia, Yi-Ping Mou, Yu-Cheng Zhou, Division of Gastrointestinal and Pancreatic Surgery, Department of General Surgery, Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College), Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou 310014, Zhejiang Province, China
Author contributions: Xiao G, Xia T, and Mou YP assembled, analyzed, and interpreted the patient’s data and case presentation; Mou YP and Zhou YC reviewed the literature; Xiao G and Mou YP prepared the original manuscript; Mou YP edited and critically revised the manuscript; all authors contributed to writing the manuscript; and all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Ping Mou, MD, Chief & Chairman, Division of Gastrointestinal and Pancreatic Surgery, Department of General Surgery, Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College), Key Laboratory of Gastroenterology of Zhejiang Province, No. 158 Shangtang Road, Gongshu District, Hangzhou 310014, Zhejiang Province, China. yipingmou@126.com
Received: March 24, 2023 Peer-review started: March 28, 2023 First decision: April 14, 2023 Revised: April 28, 2023 Accepted: May 11, 2023 Article in press: May 11, 2023 Published online: July 27, 2023
Abstract
BACKGROUND
Intraductal papillary neoplasm of the bile duct (IPNB) and intraductal papillary mucinous neoplasm (IPMN) of the pancreas have similar pathological manifestations. However, they often develop separately and it is rare for both to occur together. Patients presenting with heterochronic IPMN after IPNB are prone to be misdiagnosed with tumor recurrence.
CASE SUMMARY
A 67-year-old male patient was admitted 8.5 years after IPNB carcinoma and 4 years after the discovery of a pancreatic tumor. A left hepatic bile duct tumor with distal bile duct dilatation was found 8.5 years ago by the computed tomography; therefore, a left hepatectomy was performed. The postoperative pathological diagnosis was malignant IPNB with negative cutting edge and pathological stage T1N0M0. Magnetic resonance imaging 4 years ago showed cystic lesions in the pancreatic head with pancreatic duct dilatation, and carcinoembryonic antigen continued to increase. Positron emission tomography showed a maximum standard uptake value of 11.8 in the soft tissue mass in the pancreatic head, and a malignant tumor was considered. Radical pancreatoduodenectomy was performed. Postoperative pathological diagnosis was pancreatic head IPMN with negative cutting edge, pancreaticobiliary type, stage T3N0M0. He was discharged 15 d after the operation. Follow-up for 6 mo showed no tumor recurrence, and quality of life was good.
CONCLUSION
IPNB and IPMN are precancerous lesions with similar pathological characteristics and require active surgery and long-term follow-up.
Core Tip: We report a rare case of heterochronous onset of malignant intraductal papillary neoplasm of the bile duct (IPNB) and malignant intraductal papillary mucinous neoplasm of the pancreas (IPMN). The time difference between the onset of the two diseases was 4.5 years. Left hepatectomy and radical pancreaticoduodenectomy were performed with excellent results. This case suggests that IPNB and IPMN are precancerous lesions of low-grade malignancy that require aggressive surgery and long-term postoperative follow-up.
