Caso Maestro Óscar, Justo Alonso Iago, Rodríguez Gil Yolanda, Marcacuzco Quinto Alberto, Calvo Pulido Jorge, Jiménez Romero Carlos
Cirugía HBP y Trasplante de Órganos Abdominales, Hospital Unviersitario 12 de Octubre, España.
Cirugía HBP y Trasplante de Organos Abdominale, Hospital Universitario 12 de Octubre, España.
Rev Esp Enferm Dig. 2018 Aug;110(8):526-528. doi: 10.17235/reed.2018.5557/2018.
Intraductal papillary neoplasm of the bile duct (IPNB) or biliary papillomatosis (BP) is a premalignant entity with high risk of malignant transformation. When the disease extends widely from the intrahepatic to the extrahepatic biliary tree, liver transplantation (LT) is the only option available. We present the case of a 43-year-old male who was admitted in our hospital with an acute cholangitis. He was diagnosed of diffuse biliary and pancreatic papillomatosis. Firstly, we performed a cephalic pancreaticoduodenectomy, then we completed a total pancreatectomy, and finally, after confirming the absence of foci of carcinoma infiltration or lymph nodes involvement, a LT was performed. Foci of carcinoma infiltration or lymph nodes involvement in the liver were not found. After a two-year follow-up the patient developed liver recurrence and the biopsy showed a biliary adenocarcinoma. In 2010, Vibert et al. published a series of three cases concluding that in the absence of invasive carcinoma and positive lymph nodes, LT can be performed with success. The present case is the first to describe recurrence of the disease after LT in the absence of invasive carcinoma and positive lymph nodes in the literature. When the disease affects widely the entire biliary duct, small micro-invasive foci may not be detected. Nevertheless, although we know that it is a recurrent entity, the pathogenesis is unknown, and we do not know if it is possible that papillomatosis recurs over the new liver.
胆管内乳头状肿瘤（IPNB）或胆管乳头状瘤病（BP）是一种具有高恶变风险的癌前病变。当疾病从肝内胆管广泛蔓延至肝外胆管树时，肝移植（LT）是唯一可行的选择。我们报告一例43岁男性患者，因急性胆管炎入院。他被诊断为弥漫性胆管和胰腺乳头状瘤病。首先，我们进行了胰头十二指肠切除术，然后完成了全胰切除术，最后，在确认无癌浸润灶或淋巴结受累后，进行了肝移植。未发现肝脏有癌浸润灶或淋巴结受累。经过两年随访，患者出现肝脏复发，活检显示为胆管腺癌。2010年，维伯特等人发表了一系列三例病例，得出结论：在无浸润性癌和阳性淋巴结的情况下，肝移植可成功进行。本病例是文献中首例描述在无浸润性癌和阳性淋巴结的情况下肝移植后疾病复发的病例。当疾病广泛累及整个胆管时，可能无法检测到微小浸润灶。然而，尽管我们知道这是一种复发性疾病，但其发病机制尚不清楚，我们也不知道乳头状瘤病是否可能在新肝脏上复发。
