Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1542
Peer-review started: March 28, 2023
First decision: April 14, 2023
Revised: April 28, 2023
Accepted: May 11, 2023
Article in press: May 11, 2023
Published online: July 27, 2023
Processing time: 119 Days and 7.2 Hours
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.
Core Tip: We report a rare case of heterochronous onset of malignant intraductal papillary neoplasm of the bile duct (IPNB) and malignant intraductal papillary mucinous neoplasm of the pancreas (IPMN). The time difference between the onset of the two diseases was 4.5 years. Left hepatectomy and radical pancreaticoduodenectomy were performed with excellent results. This case suggests that IPNB and IPMN are precancerous lesions of low-grade malignancy that require aggressive surgery and long-term postoperative follow-up.