Intraductal Papillary Neoplasm of the Bile Duct: A Case Report

Abstract

On January 16, 2018, a 76-year-old male patient was admitted due to “upper abdominal pain and discomfort for over 1 week”. The patient presented with mild jaundice, no rigor and hyperpyrexia. Laboratory tests: glutamyl transpeptidase (GGT): 578U/L; alkaline phosphatase (ALP): 149U/L; Total bilirubin: 25.20umol/L; Indirect bilirubin: 20.10umol/L, CA125:8.39U/ ml, CA199:12.99U/ml. Imaging examination: abdominal enhancement MR & MRCP: nodular abnormal signal lesion about 1.7 × 1.1cm was observed in the left hepatic duct near the hepatis porta, and enhancement was observed in the enhanced scan; the upstream intrahepatic bile duct in the left lobe of the liver was significantly expanded. Intraoperative findings: The patient underwent left hemi hepatectomy & cholecystectomy. During the operation, there was free tumor embolus at the broken end of left hepatic duct. It was decided to perform common bile duct exploration. The upper segment of common bile duct was incised and removed the tumor. T-tube drainage was left in place after performing the choledochoscopy. Postoperative pathology: (left half liver and contents of bile duct cavity) intraductal papillary neoplasm, high grade, with total lesion area of about 1.1 × 0.7cm. Liver resection margin, gallbladder neck lymph node (1) and “Group 12” lymph node (3) showed no tumor. The patient was followed up for over 1 year after the surgery, without obvious abnormality (Figure 1).