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Intraductal papillary mucinous neoplasm of the biliary tract with cardiac metastasis: A case report

 Joo Hyung Lee  ;  Hyung Sun Kim  ;  Ji Hyun Park  ;  Joon Seong Park 
 MEDICINE, Vol.100(3) : e24310, 2021-01 
Journal Title
Issue Date
Abdominal Pain / etiology ; Biliary Tract Neoplasms / complications* ; Biliary Tract Neoplasms / physiopathology ; Heart* ; Hepatectomy / methods ; Humans ; Magnetic Resonance Imaging / methods ; Male ; Middle Aged ; Neoplasm Metastasis / diagnosis* ; Neoplasm Metastasis / physiopathology ; Pancreaticoduodenectomy / methods ; Papilloma, Intraductal / physiopathology*
Introduction: Intraductal papillary mucinous neoplasm of the biliary tract (IPNB) is a rare, low-grade neoplasm limited to the bile duct mucosa. The malignant transformation rate is low, and there have been limited reports of metastasis to other organs. Herein, we presented a rare case of a patient who was diagnosed with IPNB concurrent with invasive adenocarcinoma after surgery and was diagnosed with cardiac metastasis 6 months later.

Patient concerns: A 61-year-old male patient presented with abdominal pain to a local clinic. He was diagnosed with intrahepatic cholangiocarcinoma with pancreatitis and transferred to our hospital.

Diagnosis: Diagnostic testing (magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, positron emission tomography-computed tomography) revealed a papillary neoplasm and invasive adenocarcinoma with papillary neoplasm in the periampullary lesion.

Interventions: Pancreaticoduodenectomy, right hemihepatectomy, and left lateral sectionectomy of the liver were performed. After surgery, we planned gemcitabine-based adjuvant chemotherapy.

Outcomes: Upon completion of the sixth gemcitabine chemotherapy cycle, a hyperechoic, oval-shaped mass (1.3 × 2.6 cm) was found on the outer wall of the right atrium. Resection of a cardiac tumor in the right atrium and patch repair were performed.

Conclusion: To our knowledge, no other case of cardiac metastasis found during observation after surgery for an IPNB has been described. IPNBs are known to be less aggressive and to have a lower metastasis rate than intraductal papillary mucinous neoplasms; therefore, the number of case reports describing metastasis after surgery is relatively low. Our case suggests that close observation is necessary in patients diagnosed with an IPNB.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyung Sun(김형선) ORCID logo https://orcid.org/0000-0002-9002-3569
Park, Joon Seong(박준성) ORCID logo https://orcid.org/0000-0001-8048-9990
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