Extensively Invasive Gallbladder Cancer from Intracholecystic Papillary Neoplasm Treated with Pylorus-Preserving Pancreaticoduodenectomy and Extended Cholecystectomy: A Case Report and Literature Review.

IF 0.6 Q4 SURGERY Case Reports in Surgery Pub Date : 2023-01-01 DOI:10.1155/2023/5825045
Hideki Kumagai, Akira Umemura, Hiroyuki Nitta, Hirokatsu Katagiri, Masao Nishiya, Noriyuki Uesugi, Tamotsu Sugai, Akira Sasaki
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Abstract

Background: Intracholecystic papillary neoplasm (ICPN) is a rare tumor first classified by the World Health Organization in 2010. ICPN is a counterpart of the intraductal papillary mucinous neoplasm of the pancreas and intraductal papillary neoplasm of the bile duct. Previous reports on ICPN are limited; thus, the diagnosis, surgical intervention, and prognosis are controversial. Here, we report an extensively invasive gallbladder cancer arising in ICPN treated with pylorus-preserving pancreaticoduodenectomy (PPPD) and extended cholecystectomy. Case Presentation. A 75-year-old man presented to another hospital with jaundice for 1 month. Laboratory findings showed elevated total bilirubin, 10.6 mg/dL and carbohydrate antigen 19-9, 54.8 U/mL. Computed tomography showed a well-enhanced tumor located in the distal bile duct and dilated hepatic bile duct. The gallbladder wall was thickened and homogeneously enhanced. Endoscopic retrograde cholangiopancreatography revealed a filling defect in the distal common bile duct, and intraductal ultrasonography showed a papillary tumor in the common bile duct, indicating tumor invasion of the bile duct subserosa. Subsequent bile duct brush cytology revealed adenocarcinoma. The patient was referred to our hospital for surgical treatment and underwent an open PPPD. Intraoperative findings showed a thickened and indurated gallbladder wall, suggesting concurrent gallbladder cancer; thus, the patient subsequently underwent PPPD and extended cholecystectomy. Histopathological findings confirmed gallbladder carcinoma originating from ICPN, which extensively invaded the liver, common bile duct, and pancreas. The patient started adjuvant chemotherapy (tegafur/gimeracil/oteracil) 1 month after surgery and had no recurrence at follow-up after 1 year.

Conclusions: Accurate preoperative diagnosis of ICPN, including the extent of tumor invasion is challenging. To ensure complete curability, the development of an optimal surgical strategy considering preoperative examinations and intraoperative findings is essential.

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保幽门胰十二指肠及扩大胆囊切除术治疗胆囊内乳头状肿瘤广泛浸润性胆囊癌1例报告及文献复习。
背景:胆囊内乳头状肿瘤(ICPN)是2010年世界卫生组织首次分类的一种罕见肿瘤。ICPN是胰腺导管内乳头状黏液瘤和胆管导管内乳头状瘤的对应物。以前关于ICPN的报告是有限的;因此,诊断,手术干预和预后是有争议的。在这里,我们报告一例广泛侵袭性胆囊癌发生在ICPN中,采用保留幽门的胰十二指肠切除术(PPPD)和扩展胆囊切除术治疗。案例演示。75岁男性,黄疸1个月。实验室检查结果:总胆红素升高10.6 mg/dL,碳水化合物抗原19-9升高54.8 U/mL。计算机断层扫描显示肿瘤位于远端胆管和扩张的肝胆管。胆囊壁增厚均匀增强。内镜逆行胆管造影示胆总管远端充盈缺损,管内超声示胆总管乳头状肿瘤,提示肿瘤浸润至胆管浆膜下。随后的胆管刷细胞学检查显示为腺癌。患者转至我院接受手术治疗并行开放性PPPD。术中发现胆囊壁增厚硬化,提示并发胆囊癌;因此,患者随后接受PPPD和延长胆囊切除术。组织病理证实胆囊癌起源于ICPN,广泛侵犯肝脏、胆总管和胰腺。患者术后1个月开始辅助化疗(替加富/吉美拉西/奥特拉西),1年后随访无复发。结论:ICPN的术前准确诊断,包括肿瘤的侵袭程度是具有挑战性的。为了确保完全治愈,考虑术前检查和术中发现的最佳手术策略的发展是必不可少的。
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