Recurrence of distal bile duct carcinoma on percutaneous transhepatic biliary drainage fistula and lymph node of the right axilla

One potential risk of percutaneous transhepatic biliary drainage (PTBD) is tumor seeding along the catheter tract. A 72-year-old woman was referred to our hospital because of obstructive jaundice. Five weeks after inserting PTBD from the 7th right intercostal space, a pylorus-preserving pancreaticoduodenectomy was performed for the diagnosis of distal bile duct carcinoma. The patient was given a pathological diagnosis of stage I (T1 N0 M0) distal bile duct carcinoma. A tumor with rash on PTBD fistula was found and was removed 3 years after the first operation. Histological findings were compatible with bile duct carcinoma metastasis. An isolated lymph nodal mass of the right axilla was found by CT 4 years and 6 months after the first operation, and an excision biopsy was performed. Histological findings were compatible with bile duct carcinoma metastasis again. The patient underwent chemotherapy, but multiple lung metastases appeared 4 months later and she died 6 years after the first operation. We report on a case of PTBD fistula recurrence and right axillary lymph node recurrence after radical surgery for early distal bile duct carcinoma.