Journal Article

A case report of carcinoma of the papilla of Vater associated with a hyperplasia–dysplasia–carcinoma sequence by pancreaticobiliary maljunction

Kyuno, Daisuke, Kawakami, Yujiro, Kimura, Yasutoshi, Sugawara, Taro, Kato, Toru, Murota, Ayako, Murakami, Takeshi, Korai, Takahiro, Masaki, Yoshiharu, Nagayama, Minoru, Kondo, Yuta, Takemasa, Ichiro, Watanabe, Kazunori, Low, Siew-Kee, Nakase, Hiroshi, Kukita, Kazuharu, Imamura, Masafumi

2024

Overview

Background Pancreaticobiliary maljunction (PBM) is a known risk factor for biliary tract cancer. However, its association with carcinoma of the papilla of Vater (PVca) remains unknown. We report a case with PVca that was thought to be caused by the hyperplasia–dysplasia–carcinoma sequence, which is considered a mechanism underlying PBM-induced biliary tract cancer. Case presentation A 70-year-old woman presented with white stool and had a history of cholecystectomy for the diagnosis of a non-dilated biliary tract with PBM. Esophagogastroduodenoscopy revealed a tumor in the papilla of Vater, and PVca was histologically proven by biopsy. We finally diagnosed her with PVca concurrent with non-biliary dilated PBM (cT1aN0M0, cStage IA, according to the Union for International Cancer Control, 8th edition), and subsequently performed subtotal stomach-preserving pancreaticoduodenectomy. Pathological findings of the resected specimen revealed no adenomas and dysplastic and hyperplastic mucosae in the common channel slightly upstream of the main tumor, suggesting a PBM related carcinogenic pathway with hyperplasia–dysplasia–carcinoma sequence. Immunostaining revealed positivity for CEA. CK7 positivity, CK20 negativity, and MUC2 negativity indicated that this PVca was of the pancreatobiliary type. Genetic mutations were exclusively detected in tumors and not in normal tissues, and bile ducts from formalin-fixed paraffin-embedded samples included mutated- ERBB2 (Mutant allele frequency, 81.95%). Moreover, of the cell-free deoxyribonucleic acid (cfDNA) extracted from liquid biopsy mutated- ERBB2 was considered the circulating-tumor deoxyribonucleic acid (ctDNA) of this tumor. Conclusions Herein, we report the first case of PVca with PBM potentially caused by a “hyperplasia–dysplasia–carcinoma sequence” detected using immunostaining and next-generation sequencing. Careful follow-up is required if pancreaticobiliary reflux persists, considering the possible development of PVca.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Abdomen / Aged / Analysis / Antigens / Bile ducts / Bile Ducts - pathology / Bile Ducts - surgery / Biliary tract / Biliary Tract - pathology / Biliary tract diseases / Biliary Tract Neoplasms / Biopsy / Birth defects / Cancer / Carcinogens / Carcinoma / Carcinoma - pathology / Carcinoma of the papilla of Vater / Care and treatment / Case Report / Case reports / Cholangiocarcinoma / Cholecystectomy / Deoxyribonucleic acid / Diagnosis / DNA / DNA sequencing / Dysplasia / ErbB-2 protein / Female / Gallbladder cancer / Gallbladder Neoplasms - pathology / Gallbladder Neoplasms - surgery / Gene frequency / Gene mutations / Genetic aspects / Health aspects / Humans / Hyperplasia / Hyperplasia - pathology / Hyperplasia - surgery / Invoices / Liquid biopsy / Lymphatic system / Medicine / Medicine & Public Health / Metastasis / Mutation / Next-generation sequencing / Nucleotide sequencing / Pancreas / Pancreatic Ducts - pathology / Pancreaticobiliary Maljunction / Pancreaticoduodenectomy / Patient outcomes / Patients / Risk factors / Small intestine / Surgery / Surgical Oncology / Tumors