{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:49:48Z","timestamp":1782103788634,"version":"3.54.5"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Metachronous cholangiocarcinoma following curative surgery for periampullary neoplasia is a rare but serious long-term complication that poses significant diagnostic and management challenges. We report the case of a 62-year-old male who developed hilar cholangiocarcinoma 9 years after undergoing a pancreaticoduodenectomy (Whipple procedure) for an ampullary adenoma. The patient was initially diagnosed with a duodenal papillary villous tubular adenoma showing moderate dysplasia in 2015 and underwent curative resection, with no evidence of recurrence during subsequent follow-up. In 2024, he presented with obstructive jaundice and imaging findings revealing a hepatic hilar mass with intrahepatic biliary dilation. A biopsy confirmed a poorly differentiated cholangiocarcinoma (Klatskin tumor). Crucially, intraoperative exploration identified migration of the internal pancreaticojejunostomy stent to a site adjacent to the biliary-enteric anastomosis. Immunohistochemical analysis demonstrated wild-type P53 expression and proficient mismatch repair function, supporting a sporadic rather than hereditary origin. This case underscores the importance of considering second primary malignancies in patients with late-onset biliary obstruction after pancreaticoduodenectomy. We propose that the migrated and retained pancreatic stent may have acted as a chronic local irritant, potentially exacerbating inflammation and contributing to carcinogenesis within the biliary-enteric anastomotic milieu, thereby highlighting a possible long-term risk associated with indwelling surgical stents.<\/jats:p>","DOI":"10.3389\/fonc.2026.1795555","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:37:48Z","timestamp":1782103068000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Metachronous cholangiocarcinoma following pancreaticoduodenectomy and the potential role of a migrated pancreaticojejunal stent: a case report and review of the literature"],"prefix":"10.3389","volume":"16","author":[{"given":"Jing","family":"Chen","sequence":"first","affiliation":[{"name":"The Second Affiliated Hospital of Jiaxing University","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng Yi","family":"Wang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Jiaxing University","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi Xin","family":"Huang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Jiaxing University","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li Ye","family":"Zhu","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Jiaxing University","place":["Jiaxing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30289","article-title":"Intrahepatic cholangiocarcinoma: Continuing challenges and translational advances","volume":"69","author":"Sirica","year":"2019","journal-title":"Hepatology"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-200108000-00011","article-title":"Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease: a follow-up study of more than 1,000 patients","volume":"234","author":"Tocchi","year":"2001","journal-title":"Ann Surg"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.10.013","article-title":"Pathogenesis, diagnosis, and management of cholangiocarcinoma","volume":"145","author":"Ilyas","year":"2013","journal-title":"Gastroenterology"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/s0016-5085(77)80096-6","article-title":"Occurrence of an adenocarcinoma at the choledochoenteric anastomosis 14 years after pancreatoduodenectomy for benign disease","volume":"72","author":"Shields","year":"1977","journal-title":"Gastroenterology"},{"key":"B5","article-title":"Cancer of the intra-pancreatic common bile duct observed 9 years after choledochojejunostomy","volume":"29","author":"Haratake","year":"1983","journal-title":"Gan No Rinsho"},{"key":"B6","article-title":"Cancer of the bile ducts above the anastomosis following choledocoduodenal anastomosis for common bile duct lithiasis. 2 cases","volume":"38","author":"Leborgne","year":"1984","journal-title":"Ann Chir"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.147.3.513","article-title":"Cholangiocarcinoma as a late complication of choledochoenteric anastomoses","volume":"147","author":"Herba","year":"1986","journal-title":"AJR Am J Roentgenol"},{"key":"B8","article-title":"Biliary tract cancer following bilioenteric anastomosis","volume":"86","author":"P\u00e9rez Ruiz","year":"1994","journal-title":"Rev Esp Enferm Dig"},{"key":"B9","article-title":"Bile duct carcinoma in an adenoma in the anastomotic area after hepaticojejunostomy--a case report","volume":"35","author":"Schumacher","year":"1997","journal-title":"Z Gastroenterol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9610(99)00087-2","article-title":"Late bile duct cancer complicating biliary-enteric anastomosis for benign disease","volume":"177","author":"Strong","year":"1999","journal-title":"Am J Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1136\/gut.51.1.128","article-title":"Cholangiocarcinoma arising after biliary-enteric drainage procedures for benign disease","volume":"51","author":"Bettschart","year":"2002","journal-title":"Gut"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1159\/000071761","article-title":"Bile duct cancer developing 21 years after choledochoduodenostomy","volume":"20","author":"Maeda","year":"2003","journal-title":"Dig Surg"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/s0016-5107(04)01887-5","article-title":"Cholangiocarcinoma arising from a choledochoduodenal anastomosis without causing jaundice","volume":"60","author":"Lee","year":"2004","journal-title":"Gastrointest Endosc"},{"key":"B14","doi-asserted-by":"publisher","first-page":"98","DOI":"10.5582\/bst.2012.v6.2.98","article-title":"Intrahepatic cholangiocarcinoma with intrahepatic biliary lithiasis arising 47 years after the excision of a congenital biliary dilatation: report of a case","volume":"6","author":"Yamashita","year":"2012","journal-title":"Biosci Trends"},{"key":"B15","article-title":"Useful device for hepatectomy in patients with a surgical history of bile duct-GI tract anastomosis at the porta hepatis","volume":"41","author":"Amikura","year":"2014","journal-title":"Gan To Kagaku Ryoho"},{"key":"B16","article-title":"A case of distal bile duct cancer occurring 38 years after cyst-to-duct anastomosis for a congenital biliary dilatation","volume":"43","author":"Okumura","year":"2016","journal-title":"Gan To Kagaku Ryoho"},{"key":"B17","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1186\/s40792-019-0651-4","article-title":"A case of intraductal papillary neoplasm of the bile duct that developed 38\u2009years after choledochoduodenostomy with invasive adenocarcinoma and lymph node metastasis","volume":"5","author":"Kinoshita","year":"2019","journal-title":"Surg Case Rep"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/s0039-6060(97)90101-x","article-title":"Late development of bile duct cancer after sphincteroplasty: a ten- to twenty-two-year follow-up study","volume":"121","author":"Hakamada","year":"1997","journal-title":"Surgery"},{"key":"B19","doi-asserted-by":"crossref","DOI":"10.1001\/jama.2011.743","article-title":"Cancer risks associated with germline mutations in MLH1, MSH2, and MSH6 genes in Lynch syndrome","volume":"305","author":"Bonadona","year":"2011","journal-title":"Jama"},{"key":"B20","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s12920-022-01189-w","article-title":"Li-Fraumeni syndrome in Tunisian carriers with different and rare tumor phenotype: genotype-phenotype correlation","volume":"15","author":"Sassi","year":"2022","journal-title":"BMC Med Genomics"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1007\/s11605-015-2906-0","article-title":"Migration of internal pancreaticojejunostomy stents into the bile ducts in patients undergoing pancreatoduodenectomy","volume":"19","author":"Park","year":"2015","journal-title":"J Gastrointest Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"4947","DOI":"10.3390\/cancers15204947","article-title":"Primary sclerosing cholangitis-associated cholangiocarcinoma: From pathogenesis to diagnostic and surveillance strategies","volume":"15","author":"Catanzaro","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B23","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.jhep.2019.09.007","article-title":"Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: A systematic review and meta-analysis","volume":"72","author":"Clements","year":"2020","journal-title":"J Hepatol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1795555\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:37:54Z","timestamp":1782103074000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1795555\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":23,"alternative-id":["10.3389\/fonc.2026.1795555"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1795555","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]},"article-number":"1795555"}}