Photodynamic Therapy Followed by Left Hepatectomy Used to Treat an Intraductal Papillary Mucinous Neoplasm of the Bile Duct

광역학 치료 후 간 좌엽절제술이 가능하였던 담관 내 유두상 점액 종양 1예

Mucin-hypersecreting bile duct tumors, which closely resemble intraductal papillary mucinous neoplasms of the pancreas, are rare, and both the clinical features and management thereof are poorly understood. As the biliary tract and the pancreas share a common origin, the two diseases may exhibit homologous histopathological features. Certain intraductal papillary tumors of the bile duct are associated with production of large amounts of mucin that disturb bile flow and cause severe biliary dilatation, obstructive jaundice, and cholangitis. Herein, we report on a patient with an extensive intraductal papillary mucinous neoplasm of the bile duct, involving both the right and left intrahepatic ducts. The ducts were subjected to photodynamic therapy, followed by left hepatectomy. The surgical specimen revealed an adenocarcinoma with a negative resection margin. Photodynamic therapy of the intrahepatic ducts was well-tolerated in the present case, and may serve as a useful therapeutic option for selected patients with intraductal papillary mucinous neoplasms of the bile duct.

IPMN은 매우 드문 질환으로 내시경상 IPMN이 의심될 경우 조직학적 진단을 통해 악성 종양의 가능성을 항상 고려해야 하고 정확한 감별 진단이 필요하다. 또한 IPMN이 담관계 내 수술 범위가 넓은 경우에는 치료 방침이 명확하지 않은 실정이다. 이에 저자들은 수술적 절제가 어려운 광범위한 IPMN에 대해 PDT 후 간 좌엽절제술을 시행한 증례를 보고한다.