Duodenal Adenocarcinoma Recurrence Limited to the Choledochojejunostomy After Pancreaticoduodenectomy: A Case Suggesting Intraluminal Implantation With a Distinct Mucin Phenotypic Shift.
Yukihiro Shirota, Yoshimichi Ueda, Azusa Kawasaki et al.
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Case in brief
A 59-year-old man developed recurrence at the choledochojejunostomy 27 months after pancreaticoduodenectomy for duodenal adenocarcinoma, despite five surgically created raw surfaces. The recurrent tumor retained the primary tumor’s intestinal immunophenotype (CK7−/CK20+) but had a different mucin profile: MUC5AC and MUC2 were present, whereas MUC6 and CA19-9 were no longer detected. Radiotherapy achieved temporary local control; peritoneal carcinomatosis subsequently developed, and he died 54 months after surgery.
What made this case unusual
The recurrence was confined to the choledochojejunostomy and showed a mucin phenotypic shift, including newly detected MUC5AC. The authors considered the pattern compatible with intraluminal implantation and proposed, without establishing, that bile acid-associated modulation of exfoliated tumor cells may have contributed.
Diagnostic / clinical pearl
A recurrence at a surgically created anastomosis with a changed mucin profile may be compatible with intraluminal implantation; comparison of the recurrent lesion with the primary tumor can reveal phenotypic shifts relevant to that hypothesis.