[pT2 Gallbladder Cancer with Suspected Intrapancreatic Bile Duct Recurrence Four Years Postoperatively-A Case...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Gallbladder cancer (pT2a) treated with laparoscopic cholecystectomy and subsequent radical resection.
• Postoperative surveillance via computed tomography (CT) scans at 6-month intervals.
• A 58-year-old female patient with no residual cancer reported initially.

Purpose of the Study:

• To report a unique case of late, intrapancreatic bile duct recurrence of gallbladder cancer.
• To highlight the diagnostic and therapeutic challenges of such rare presentations.
• To emphasize the importance of long-term follow-up in gallbladder cancer patients.

Main Methods:

• Laparoscopic cholecystectomy followed by gallbladder bed resection, extrahepatic bile duct resection, and choledochojejunostomy.
• Postoperative surveillance with abdominal CT scans.
• Treatment with GEM+CDDP chemotherapy for suspected recurrence.
• Surgical resection (pancreaticoduodenectomy) for confirmed intrapancreatic recurrence.

Main Results:

• A 3-cm mass in the pancreatic head, identified 4 years postoperatively, was diagnosed as gallbladder cancer recurrence in the bile duct.
• The recurrent mass showed poor contrast on CT and was initially treated with three courses of GEM+CDDP chemotherapy.
• Post-chemotherapy, the mass was no longer identifiable on imaging, leading to surgical intervention.
• Histopathological examination of the resected specimen revealed a 5 mm nodular mass, a poorly differentiated adenocarcinoma, consistent with gallbladder cancer recurrence.

Conclusions:

• Intrapancreatic bile duct recurrence of gallbladder cancer is rare but possible, even years after curative-intent surgery.
• Chemotherapy can be effective in managing such late recurrences, potentially rendering them amenable to surgical resection.
• Long-term surveillance is crucial for early detection of distant or unusual recurrences in gallbladder cancer survivors.