Cutaneous metastases from cholangiocarcinoma following percutaneous transhepatic biliary drainage: Case report and literature review

Abstract

Percutaneous transhepatic biliary drainage (PTBD) is commonly used in the management of cholangiocarcioma. Major and minor complications of PTBD such as cholangitis, haemorrhage and catheter dislocation are well documented. A lesser reported complication are cutaneous metastases following PTBD for cholangiocarcinoma.We report a case of a 79 year old man who presented with right upper quadrant pain, jaundice and weight loss, with dilated intra-hepatic bile ducts on imaging. The cytology results from a sample taken during endoscopic retrograde cholangiopancreatography were highly suspicious of cholangiocarcioma. A PTBD was subsequently performed and bilateral metal biliary stents were placed without external drainage. Five months after the PTBD he was found to have a hard nodule under the PTBD puncture site. The nodule was excised and the histology confirmed a cholangiocarcinoma metastasis.A review of the literature identified twelve cases of cutaneous metastases from cholangiocarcinoma, following PTBD. In addition, tumour seeding along the catheter tract following PTBD, with metastatic deposits on the abdominal wall, peritoneoum, chest wall, pleural space, and liver parenchyma have also been reported.Health care professionals should be aware of this rare complication and offer appropriate management options to patients.

Isolated implant metastasis in chest wall due to seeding of transpleurally placed PTBD catheter tract in a case of hilar cholangiocarcinoma

“…A pooled analysis of all reported cases until 2005 (n=10) found that the median time to detection was 14 months postinsertion, 60% were isolated and 40% had well differentiated tumour histology 5. A similar review by Rosich-Medina et al 16 subsequently showed that the mean age of patients was 68 years and mean time to detection was 9 months with a male predominance. Based on their 30 years of experience (1977–2007) of treating 445 patients with cholangiocarcinoma with preoperative PTBD, Takahashi et al 6 reported 25 catheter tract recurrences in 23 patients (two patients with two metastases each; incidence 5.2%).…”

“…The median survival of six patients undergoing resection was 22.5 months (range 9–65 months) with two surviving beyond 5 years and three surviving more than 2 years 5. In a review by Rosich-Medina et al ,16 postexcision median survival was 10.5 months (n=4; range 8–18 months).…”

Laparoscopic liver resection with open partial resection of the thoracoabdominal wall for cancer along the transhepatic biliary drainage tract: A case report

“…For recurrent cancer of the biliary tract or the ampulla of Vater, various chemotherapies have been used as best practices for treatment, but surgery might be feasible and may offer longer survival for select patients [11] , [12] , [13] . As for PTBD catheter tract recurrence with no other forms of metastasis from bile duct cancer, aggressive surgical treatment could offer a better prognosis [14] , [15] , [16] . To the best of our knowledge, there have been no reports on resected biliary drainage tract recurrence of cancer of the ampulla of Vater with relatively long survival after resection of 46 months.…”