Xiao Gang, Xia Tao, Mou Yi-Ping, Zhou Yu-Cheng
Department of Hepatopancreatobiliary Surgery, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang Province, China.
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.
World J Gastrointest Surg. 2023 Jul 27;15(7):1542-1548. doi: 10.4240/wjgs.v15.i7.1542.
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.
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.
IPNB and IPMN are precancerous lesions with similar pathological characteristics and require active surgery and long-term follow-up.
胆管内乳头状肿瘤（IPNB）与胰腺导管内乳头状黏液性肿瘤（IPMN）具有相似的病理表现。然而，它们通常各自独立发生，两者同时出现的情况较为罕见。IPNB后出现异时性IPMN的患者容易被误诊为肿瘤复发。
一名67岁男性患者，在IPNB癌发生8.5年后、发现胰腺肿瘤4年后入院。8.5年前计算机断层扫描发现左肝内胆管肿瘤伴远端胆管扩张，因此行左肝切除术。术后病理诊断为恶性IPNB，切缘阴性，病理分期为T1N0M0。4年前磁共振成像显示胰头有囊性病变伴胰管扩张，癌胚抗原持续升高。正电子发射断层扫描显示胰头软组织肿块的最大标准摄取值为11.8，考虑为恶性肿瘤，遂行根治性胰十二指肠切除术。术后病理诊断为胰头IPMN，切缘阴性，胰胆管型，分期为T3N0M0。术后15天出院。随访6个月显示无肿瘤复发，生活质量良好。
IPNB和IPMN是具有相似病理特征的癌前病变，需要积极手术及长期随访。
