Implantation metastasis along the percutaneous transhepatic biliary drainage sinus tract.
We describe herein the case of a 75-year-old man with metastatic tumor seeding at the percutaneous transhepatic biliary drainage tract that occurred following a pylorus-preserving pancreatoduodenectomy for carcinoma of the distal common bile duct. On postoperative day 30, the catheter was removed and ethanol was injected into the percutaneous transhepatic biliary drainage sinus tract to prevent cancer implantation. One year and 3 months after the initial operation, abdominal computed tomography showed dilation of the left lateral segmental bile ducts and a 2-cm mass. The location of this mass corresponded to the puncture point from the previously performed percutaneous transhepatic biliary drainage. Implantation of the bile duct carcinoma at the percutaneous transhepatic biliary drainage sinus tract was diagnosed, and the recurrent tumor was successfully resected by performing a left hepatic lobectomy. Currently, 1 year after the second operation, the patient is in good health without any signs of recurrence. This case report demonstrates the importance of resecting the percutaneous transhepatic biliary drainage sinus tract during the initial surgery. If left in place, careful follow-up and awareness of this mode of tumor recurrence may lead to a timely resection, with preservation of a good quality of life and long-term survival.
Shimizu
Yasuhiro
Y
Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan. yshimizu@aichi-cc.jp
Yasui
Kenzo
K
Kato
Tomoyuki
T
Yamamura
Yoshitaka
Y
Hirai
Takashi
T
Kodera
Yasuhiro
Y
Kanemitsu
Yukihide
Y
Ito
Seiji
S
Shibata
Naoshi
N
Yamao
Kenji
K
Ohhashi
Kazuhiko
K
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D001652:Bile Ducts / Q000473:pathology; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004108:Dilatation, Pathologic; D004322:Drainage; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery; D008113:Liver Neoplasms / Q000209:etiology / Q000601:surgery; D008297:Male; D009366:Neoplasm Seeding; D016577:Pancreaticoduodenectomy