Kwon Hyung Jun, Kim Sang Geol, Chun Jae Min, Hwang Yoon Jin
Hyung Jun Kwon, Sang Geol Kim, Yoon Jin Hwang, Department of Surgery, Kyungpook National University Medical Center, Daegu 702-210, South Korea.
World J Gastroenterol. 2014 Mar 21;20(11):3050-5. doi: 10.3748/wjg.v20.i11.3050.
Extrahepatic bile duct (EHBD) cancer may occur metachronously, and these cancers are resectable with a favorable prognosis. We aimed to identify the pattern of metachronous EHBD cancer. We classified the cases of metachronous EHBD cancer reported in the literature thus far and investigated two new cases of metachronous EHBD cancer. A 70-year-old female underwent R0 bile duct resection for a type 1 Klatskin tumor (pT1N0M0). A 70-year-old male patient underwent R0 bile duct resection for a middle bile duct cancer (pT2N1M0). Imaging studies of both patients taken at 14 and 24 mo after first surgery respectively revealed a metachronous cholangiocarcinoma that required pancreaticoduodenectomy (PD). Histopathology of the both tumors after PD revealed cholangiocarcinoma invading the pancreas (pT3N0M0). Both patients have been free from recurrence for 6 years and 16 mo respectively after the second surgery. Through a review of the literature on these cases, we classified the pattern of metachronous EHBD cancer according to the site of de novo neoplasia. The proximal remnant bile duct was most commonly involved. Metachronous EHBD cancer should be distinguished from an unresectable recurrent tumor. Classifying metachronous EHBD cancer may be helpful in identifying rare metachronous tumors.
肝外胆管（EHBD）癌可能异时发生，并且这些癌症可切除，预后良好。我们旨在确定异时性EHBD癌的模式。我们对迄今为止文献中报道的异时性EHBD癌病例进行了分类，并研究了两例异时性EHBD癌的新病例。一名70岁女性因1型Klatskin肿瘤（pT1N0M0）接受了R0胆管切除术。一名70岁男性患者因中段胆管癌（pT2N1M0）接受了R0胆管切除术。分别在首次手术后14个月和24个月对两名患者进行的影像学检查显示，出现了需要行胰十二指肠切除术（PD）的异时性胆管癌。PD术后两个肿瘤的组织病理学检查显示胆管癌侵犯胰腺（pT3N0M0）。两名患者在第二次手术后分别已无复发6年和16个月。通过对这些病例的文献回顾，我们根据新生肿瘤的部位对异时性EHBD癌的模式进行了分类。近端残余胆管最常受累。异时性EHBD癌应与不可切除的复发性肿瘤相鉴别。对异时性EHBD癌进行分类可能有助于识别罕见的异时性肿瘤。
