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Varshney P, Varshney VK, Saikrishna E. ASO Author Reflections: Simplifying Complex Biliary Reconstruction in Parenchyma-Preserving Liver Surgery. Ann Surg Oncol 2024:10.1245/s10434-024-16076-0. [PMID: 39145827 DOI: 10.1245/s10434-024-16076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 08/01/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Peeyush Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Eswaravaka Saikrishna
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Saikrishana E, Varshney P, Varshney VK, Soni SC, Selvakumar B, Agarwal L. En Bloc Extrahepatic Biliary Tract Excision with Triple Cholangiojejunostomy for Complex Hilar Intraductal Papillary Neoplasm of the Liver. Ann Surg Oncol 2024:10.1245/s10434-024-15954-x. [PMID: 39085553 DOI: 10.1245/s10434-024-15954-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024]
Affiliation(s)
- E Saikrishana
- All India Institute of Medical Sciences, Jodhpur, India
| | - Peeyush Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India.
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Subash Chandra Soni
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - B Selvakumar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Lokesh Agarwal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
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Huang XH, Chen TX, Liu HL, Huang MW. A Review of Type 1 and Type 2 Intraductal Papillary Neoplasms of the Bile Duct. Curr Med Sci 2024; 44:485-493. [PMID: 38748369 DOI: 10.1007/s11596-024-2863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/29/2024] [Indexed: 06/29/2024]
Abstract
Intraductal papillary neoplasm of the bile duct (IPNB) is a heterogeneous disease similar to intraductal papillary mucinous neoplasm of the pancreas. These lesions have been recognized as one of the three major precancerous lesions in the biliary tract since 2010. In 2018, Japanese and Korean pathologists reached a consensus, classifying IPNBs into type l and type 2 IPNBs. IPNBs are more prevalent in male patients in East Asia and are closely related to diseases such as cholelithiasis and schistosomiasis. From a molecular genetic perspective, IPNBs exhibit early genetic variations, and different molecular pathways may be involved in the tumorigenesis of type 1 and type 2 IPNBs. The histological subtypes of IPNBs include gastric, intestinal, pancreaticobiliary, or oncocytic subtypes, but type 1 IPNBs typically exhibit more regular and well-organized histological features than type 2 IPNBs and are more commonly found in the intrahepatic bile ducts with abundant mucin. Due to the rarity of these lesions and the absence of specific clinical and laboratory features, imaging is crucial for the preoperative diagnosis of IPNB, with local bile duct dilation and growth along the bile ducts being the main imaging features. Surgical resection remains the optimal treatment for IPNBs, but negative bile duct margins and the removal of lymph nodes in the hepatic hilum significantly improve the postoperative survival rates for patients with IPNBs.
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Affiliation(s)
- Xia-Hui Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Tian-Xiang Chen
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Hong-Liang Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Ming-Wen Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
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Zilberstein N, Mehta NA, Al-Sabti R, Waxman I. Characterizing the extent and morphology of intraductal mucinous biliary neoplasm using a novel cholangioscope and treatment with ampullectomy. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:283-285. [PMID: 38887736 PMCID: PMC11180357 DOI: 10.1016/j.vgie.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Video 1A case characterizing the extent and morphology of an intraductal mucinous biliary neoplasm using a novel cholangioscope and treatment with ampullectomy.
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Affiliation(s)
- Netanel Zilberstein
- Center for Interventional and Therapeutic Endoscopy, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Neal A Mehta
- Center for Interventional and Therapeutic Endoscopy, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Ram Al-Sabti
- Department of Pathology, Rush Medical College, Chicago, Illinois
| | - Irving Waxman
- Center for Interventional and Therapeutic Endoscopy, Division of Digestive Disease and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
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Luvira V. Tri-modal death distribution towards personalized management of intraductal papillary neoplasm of the bile duct patients: Every story has its own conclusion. Hepatobiliary Pancreat Dis Int 2024; 23:313-316. [PMID: 38290936 DOI: 10.1016/j.hbpd.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Vor Luvira
- Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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Chun J, Sung YN, An S, Hong SM. Oncocytic type has distinct immunohistochemical and recurrence-free survival than other histologic types of the intraductal papillary neoplasm of the bile duct. Hum Pathol 2024; 148:72-80. [PMID: 38782100 DOI: 10.1016/j.humpath.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
Although intraductal oncocytic papillary neoplasm (IOPN) was considered distinct from the intraductal papillary neoplasm of the pancreas, the oncocytic histologic type remained as a subtype of intraductal papillary neoplasms of the bile duct (IPNBs) with gastric, intestinal, and pancreatobiliary types based on the fifth edition of the WHO classification. To test the characteristics of the oncocytic type of IPNBs, the histopathologic, immunohistochemical (Hep Par-1 and CD117), and clinical characteristics of 13 oncocytic type were compared with 114 others (15 gastric, 39 pancreatobiliary, and 60 intestinal) IPNB types. The oncocytic type, which occupied about 9% of IPNBs, was more frequent in females (p < 0.05) and larger (mean, 5.3 vs. 3.6 cm; p < 0.002) than other IPNB types. Immunohistochemically, the oncocytic type had more frequent combined Hep Par-1 and CD117 expression than other IPNB types (all p < 0.05). The recurrence-free survival rate for patients with the oncocytic type (5-year survival, 100%) was significantly higher (p = 0.015) than for those with other histologic types (59.9%). The oncocytic type had distinct histopathologic, immunohistochemical, and survival outcomes from other IPNBs. Therefore, it can be separated from other IPNB types and classified as one independent entity, similar to IOPN of the pancreas.
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Affiliation(s)
- Jihyun Chun
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - You-Na Sung
- Department of Pathology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soyeon An
- Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Ren X, Qu YP, Zhu CL, Xu XH, Jiang H, Lu YX, Xue HP. Percutaneous transhepatic cholangioscopy-assisted biliary polypectomy for local palliative treatment of intraductal papillary neoplasm of the bile duct. World J Gastrointest Oncol 2024; 16:1821-1832. [PMID: 38764829 PMCID: PMC11099459 DOI: 10.4251/wjgo.v16.i5.1821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/29/2024] [Accepted: 03/11/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile duct (IPNB) is a premalignant biliary-type epithelial neoplasm with intraductal papillary or villous growth. Currently reported local palliative therapeutic modalities, including endoscopic nasobiliary drainage, stenting and biliary curettage, endoscopic biliary polypectomy, percutaneous biliary drainage, laser ablation, argon plasma coagulation, photodynamic therapy, and radiofrequency ablation to relieve mechanical obstruction are limited with weaknesses and disadvantages. We have applied percutaneous transhepatic cholangioscopy (PTCS)-assisted biliary polypectomy (PTCS-BP) technique for the management of IPNB including mucin-hypersecreting cast-like and polypoid type tumors since 2010. AIM To assess the technical feasibility, efficacy, and safety of PTCS-BP for local palliative treatment of IPNB. METHODS Patients with mucin-hypersecreting cast-like or polypoid type IPNB and receiving PTCS-BP between September 2010 and December 2019 were included. PTCS-BP was performed by using a half-moon type snare with a soft stainless-steel wire, and the tumor was snared and resected with electrocautery. The primary outcome was its feasibility, indicated by technical success. The secondary outcomes were efficacy, including therapeutic success, curative resection, and clinical success, and safety. RESULTS Five patients (four with mucin-hypersecreting cast-like type and one with polypoid type IPNB) were included. Low- and high-grade intraepithelial neoplasia (HGIN) and recurrent IPNB with invasive carcinoma were observed in one, two, and two patients, respectively. Repeated cholangitis and/or obstructive jaundice were presented in all four patients with mucin-hypersecreting cast-like type IPNB. All five patients achieved technical success of PTCS-BP. Four patients (three with mucin-hypersecreting cast-like type and one with polypoid type IPNB) obtained therapeutic success; one with mucin-hypersecreting cast-like type tumors in the intrahepatic small bile duct and HGIN had residual tumors. All four patients with mucin-hypersecreting IPNB achieved clinical success. The patient with polypoid type IPNB achieved curative resection. There were no PTCS-BP-related serious adverse events. CONCLUSION PTCS-BP appears to be feasible, efficacious, and safe for local palliative treatment of both mucin-hypersecreting cast-like and polypoid type IPNB.
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Affiliation(s)
- Xu Ren
- Digestive Disease Hospital of Heilongjiang Provincial Hospital, Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, Harbin 150001, Heilongjiang Province, China
| | - Yong-Ping Qu
- Digestive Endoscopy Center of Heilongjiang Provincial Hospital, Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, Harbin 150001, Heilongjiang Province, China
| | - Chun-Lan Zhu
- Second Department of Gastroenterology, Digestive Disease Hospital of Heilongjiang Provincial Hospital, and Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, Harbin 150001, Heilongjiang Province, China
| | - Xiao-Hong Xu
- Second Department of Gastroenterology, Digestive Disease Hospital of Heilongjiang Provincial Hospital, and Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, Harbin 150001, Heilongjiang Province, China
| | - Hong Jiang
- Department of Pathology, Heilongjiang Provincial Hospital, Harbin 150001, Heilongjiang Province, China
| | - Yi-Xia Lu
- Second Department of Gastroenterology, Digestive Disease Hospital of Heilongjiang Provincial Hospital, and Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, Harbin 150001, Heilongjiang Province, China
| | - Hong-Peng Xue
- Second Department of Gastroenterology, Digestive Disease Hospital of Heilongjiang Provincial Hospital, and Heilongjiang Provincial Clinical Medical Research Center for Minimally Invasive Diagnosis and Treatment of Pancreaticobiliary Diseases, Harbin 150001, Heilongjiang Province, China
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Akita M, Yanagimoto H, Tsugawa D, Zen Y, Fukumoto T. Surgical interpretation of the WHO subclassification of intrahepatic cholangiocarcinoma: a narrative review. Surg Today 2024:10.1007/s00595-024-02825-x. [PMID: 38563999 DOI: 10.1007/s00595-024-02825-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/14/2024] [Indexed: 04/04/2024]
Abstract
Intrahepatic cholangiocarcinoma (iCCA) has been subclassified by its gross morphology into the mass-forming (MF), periductal-infiltrating (PI), and intraductal growth (IG) types and their combinations. This classification correlates well with clinical features; for example, MF-iCCA has less lymph-node metastasis and a better prognosis than PI-iCCA. According to the recently accumulated evidence from histological investigations, the WHO classification endorsed a subclassification scheme in which iCCA cases are classified into small- and large-duct types. Small-duct iCCA is considered to originate from septal or smaller bile ducts and is characterized by less frequent lymph-node metastasis, a favorable prognosis, and an MF appearance. Large-duct iCCA arises around the second branch of the biliary tree and has more aggressive biology and distinct genetic abnormalities. According to the practice guidelines for iCCA from the Liver Cancer Study Group of Japan and the National Comprehensive Cancer Network, upfront surgery is recommended for iCCA without distant metastasis regardless of the morphological subtype, based on clinical experience. In consideration of the biological heterogeneity of iCCA, the treatment strategy for iCCA needs to be reconsidered based on the WHO subtypes.
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Affiliation(s)
- Masayuki Akita
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Hiroaki Yanagimoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan.
| | - Daisuke Tsugawa
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
| | - Yoh Zen
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan
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Lluís N, Onoe S, Serradilla-Martín M, Achalandabaso M, Mizuno T, Jehaes F, Dasari BVM, Mambrilla-Herrero S, Sparrelid E, Balakrishnan A, Hoogwater FJH, Amaral MJ, Andersson B, Berrevoet F, Doussot A, López-López V, Detry O, Pozo CDD, Machairas N, Pekli D, Alcázar-López CF, Asbun H, Björnsson B, Christophides T, Díez-Caballero A, Francart D, Noel CB, Sousa-Silva D, Toledo-Martínez E, Tzimas GN, Yaqub S, Yamaguchi J, Dokmak S, Prieto-Calvo M, D'Souza MA, Spiers HVM, van den Heuvel MC, Charco R, Lesurtel M, Ebata T, Ramia JM. Intraductal papillary neoplasms of the bile ducts: a comparative study of a rare disease in Europe and Nagoya, Japan. HPB (Oxford) 2024; 26:565-575. [PMID: 38307773 DOI: 10.1016/j.hpb.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/27/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile ducts (IPNB) is a rare disease in Western countries. The aim of this study was to compare tumor characteristics, management strategies, and outcomes between Western and Eastern patients who underwent surgical resection for IPNB. METHODS A multi-institutional retrospective series of patients with IPNB undergoing surgery between January 2010 and December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA), and at Nagoya University Hospital, Japan. RESULTS A total of 85 patients (51% male; median age 66 years) from 28 E-AHPBA centers were compared to 91 patients (64% male; median age 71 years) from Nagoya. Patients in Europe had more multiple lesions (23% vs 2%, P < .001), less invasive carcinoma (42% vs 85%, P < .001), and more intrahepatic tumors (52% vs 24%, P < .001) than in Nagoya. Patients in Europe experienced less 90-day grade >3 Clavien-Dindo complications (33% vs 68%, P < .001), but higher 90-day mortality rate (7.0% vs 0%, P = .03). R0 resections (81% vs 82%) were similar. Overall survival, excluding 90-day postoperative deaths, was similar in both regions. DISCUSSION Despite performing more extensive resections, the low perioperative mortality rate observed in Nagoya was probably influenced by a combination of patient-, tumor-, and surgery-related factors.
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Affiliation(s)
- Núria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA.
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mario Serradilla-Martín
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain.
| | - Mar Achalandabaso
- HPB Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - François Jehaes
- HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Bobby V M Dasari
- Liver Transplant and HPB Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Sara Mambrilla-Herrero
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anita Balakrishnan
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust, and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Frederik J H Hoogwater
- HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - María J Amaral
- General Surgery, Centro Hospitalar e Universitário de Coimbra, and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Bodil Andersson
- Department of Clinical Science Lund, Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Frederik Berrevoet
- General and HPB Surgery, and Liver Transplantation, University Hospital Gent, Gent, Belgium
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - Víctor López-López
- General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Olivier Detry
- Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Belgium
| | | | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Damján Pekli
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Cándido F Alcázar-López
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Horacio Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thalis Christophides
- General Surgery Department, HPB Division, Nicosia General Hospital, Nicosia, Cyprus
| | | | - David Francart
- Department of Abdominal Surgery, CHC Groupe Santé, Liège, Belgium
| | - Colin B Noel
- HPB Clinical Unit, Gastrointestinal Surgery, Universitas Academic Hospital, University of the Free State, South Africa
| | | | | | - George N Tzimas
- HPB Surgery, Department of Surgery, Hygeia Hospital, Athens, Greece
| | - Sheraz Yaqub
- HPB Surgery, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Safi Dokmak
- HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Mikel Prieto-Calvo
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
| | - Melroy A D'Souza
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Harry V M Spiers
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust, and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Marius C van den Heuvel
- HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ramón Charco
- HPB Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Mickaël Lesurtel
- HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - José M Ramia
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Miguel Hernández University, Alicante, Spain
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Nakahata A, Yamashita Y, Yamazaki H, Tsuda I, Kawaji Y, Ashida R, Kitano M. Intraductal Papillary Neoplasm of the Bile Duct Treated with Argon Plasma Coagulation via Endoscopic Ultrasound-guided Choledochoduodenostomy. Intern Med 2024; 63:957-962. [PMID: 37612086 PMCID: PMC11045366 DOI: 10.2169/internalmedicine.2083-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/25/2023] [Indexed: 08/25/2023] Open
Abstract
A 93-year-old man presented to our hospital with a fever, abdominal pain, and jaundice. Computed tomography revealed bilateral bile duct dilation, cystic lesions with bile duct communication, and intraluminal solid nodules arising from the bile duct wall. The patient was diagnosed with intraductal papillary neoplasm of the bile duct. Surgery was not performed, considering the patient's age. It was impossible to control cholangitis using conventional endoscopic therapy. We therefore created an access route to the bile duct using endoscopic ultrasound-guided choledochoduodenostomy and inserted a lumen-apposed metal stent. Thereafter, we performed argon plasma coagulation of the tumor in the bile duct, which successfully prevented cholangitis recurrence.
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Affiliation(s)
- Akiya Nakahata
- Second Department of Internal Medicine, Wakayama Medical University, Japan
| | - Yasunobu Yamashita
- Second Department of Internal Medicine, Wakayama Medical University, Japan
| | - Hirofumi Yamazaki
- Second Department of Internal Medicine, Wakayama Medical University, Japan
| | - Ikuhisa Tsuda
- Second Department of Internal Medicine, Wakayama Medical University, Japan
| | - Yuuki Kawaji
- Second Department of Internal Medicine, Wakayama Medical University, Japan
| | - Reiko Ashida
- Second Department of Internal Medicine, Wakayama Medical University, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Japan
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Kraus M, Klang E, Soffer S, Inbar Y, Konen E, Sobeh T, Apter S. MRI features of intraductal papillary mucinous neoplasm of the bile ducts, "The myth about the cyst": A systematic review. Eur J Radiol Open 2023; 11:100515. [PMID: 37609049 PMCID: PMC10440390 DOI: 10.1016/j.ejro.2023.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/03/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Rationale and objectives Intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is a true pre-cancerous lesion, which shares common features with pancreatic IPMN (IPMN-P). While IPMN-P is a well described entity for which guidelines were formulated and revised, IPMN-B is a poorly described entity.We carried out a systematic review to evaluate the existing literature, emphasizing the role of MRI in IPMN-B depiction. Materials and methods PubMed database was used to identify original studies and case series that reported MR Imaging features of IPMN-B. The search keywords were "IPMN OR intraductal papillary mucinous neoplasm OR IPNB OR intraductal papillary neoplasm of the bile duct AND Biliary OR biliary cancer OR hepatic cystic lesions". Risk of bias and applicability were evaluated using the QUADAS-2 tool. Results 884 Records were Identified through database searching. 12 studies satisfied the inclusion criteria, resulting in MR features of 288 patients. All the studies were retrospective. Classic features of IPMN-B are under-described. Few studies note worrisome features, concerning for an underlying malignancy. 50 % of the studies had a high risk of bias and concerns regarding applicability. Conclusions The MRI features of IPMN-B are not well elaborated and need to be further studied. Worrisome features and guidelines regarding reporting the imaging findings should be established and published. Radiologists should be aware of IPMN-B, since malignancy diagnosis in an early stage will yield improved prognosis.
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Affiliation(s)
- Matan Kraus
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel
- Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yael Inbar
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamer Sobeh
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Apter
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Möller K, Braden B, Jenssen C, Ignee A, Cui XW, Yamashita Y, Kitano M, Faiss S, Sun S, Dietrich CF. Intraductal papillary neoplasms of the bile ducts-what can be seen with ultrasound? Endosc Ultrasound 2023; 12:445-455. [PMID: 38948129 PMCID: PMC11213588 DOI: 10.1097/eus.0000000000000040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Intraductal papillary neoplasm of the bile ducts is a rare tumor. Characteristic features include bile duct dilatation, cystic lesions with communication to the bile ducts, and intraluminal solid nodules arising from the bile duct wall. As in pancreatic intraductal papillary mucinous neoplasia, intestinal, pancreaticobiliary, gastric, and oncocytic types are described. Intraductal papillary neoplasm of the bile ducts has a high potential for malignancy, and patients should be surgically resected when possible. In this review, the complex imaging diagnosis is presented. The main focus is on contrast-enhanced ultrasound, an established method for many other indications whose potential on the biliary system should be better exploited. In the present article, typical contrast-enhanced ultrasound findings in intraductal papillary neoplasm of the bile ducts are demonstrated.
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Affiliation(s)
- Kathleen Möller
- Sana Hospital Lichtenberg, Medical Department I/Gastroenterology, Berlin, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christian Jenssen
- Krankenhaus Märkisch-Oderland, Department of Internal Medicine, Strausberg, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg, Neuruppin, Germany
| | - André Ignee
- Medical Clinic, Department for Gastroenterology and Rheumatology, Klinikum Wuerzburg Mitte, Wuerzburg, Germany
| | - Xin Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yasunobu Yamashita
- Second Department of Internal Medicine, Wakayama Medical University, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Japan
| | - Siegbert Faiss
- Sana Hospital Lichtenberg, Medical Department I/Gastroenterology, Berlin, Germany
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Christoph F. Dietrich
- Department of Internal Medicine (DAIM). Hirslanden Private Hospital Beau Site, Salem und Permanence, Bern, Switzerland
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13
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Mocchegiani F, Vincenzi P, Conte G, Nicolini D, Rossi R, Cacciaguerra AB, Vivarelli M. Intraductal papillary neoplasm of the bile duct: The new frontier of biliary pathology. World J Gastroenterol 2023; 29:5361-5373. [PMID: 37900587 PMCID: PMC10600795 DOI: 10.3748/wjg.v29.i38.5361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/07/2023] [Accepted: 08/31/2023] [Indexed: 10/12/2023] Open
Abstract
Intraductal papillary neoplasms of the bile duct (IPNBs) represent a rare variant of biliary tumors characterized by a papillary growth within the bile duct lumen. Since their first description in 2001, several classifications have been proposed, mainly based on histopathological, radiological and clinical features, although no specific guidelines addressing their management have been developed. Bile duct neoplasms generally develop through a multistep process, involving different precursor pathways, ranging from the initial lesion, detectable only microscopically, i.e. biliary intraepithelial neoplasia, to the distinctive grades of IPNB until the final stage represented by invasive cholangiocarcinoma. Complex and advanced investigations, mainly relying on magnetic resonance imaging (MRI) and cholangioscopy, are required to reach a correct diagnosis and to define an adequate bile duct mapping, which supports proper treatment. The recently introduced subclassifications of types 1 and 2 highlight the histopathological and clinical aspects of IPNB, as well as their natural evolution with a particular focus on prognosis and survival. Aggressive surgical resection, including hepatectomy, pancreaticoduodenectomy or both, represents the treatment of choice, yielding optimal results in terms of survival, although several endoscopic approaches have been described. IPNBs are newly recognized preinvasive neoplasms of the bile duct with high malignant potential. The novel subclassification of types 1 and 2 defines the histological and clinical aspects, prognosis and survival. Diagnosis is mainly based on MRI and cholangioscopy. Surgical resection represents the mainstay of treatment, although endoscopic resection is currently applied to nonsurgically fit patients. New frontiers in genetic research have identified the processes underlying the carcinogenesis of IPNB, to identify targeted therapies.
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Affiliation(s)
- Federico Mocchegiani
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona 60126, Italy
| | - Paolo Vincenzi
- Department of Gastroenterology and Transplant, United Hospital of Marche, Ancona 60126, Italy
| | - Grazia Conte
- Department of Gastroenterology and Transplant, United Hospital of Marche, Ancona 60126, Italy
| | - Daniele Nicolini
- Department of Gastroenterology and Transplant, United Hospital of Marche, Ancona 60126, Italy
| | - Roberta Rossi
- Department of Gastroenterology and Transplant, United Hospital of Marche, Ancona 60126, Italy
| | | | - Marco Vivarelli
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona 60126, Italy
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14
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Kim JR, Jang KT, Jang JY. Intraductal papillary neoplasm of the bile duct: review of updated clinicopathological and imaging characteristics. Br J Surg 2023; 110:1229-1240. [PMID: 37463281 DOI: 10.1093/bjs/znad202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/04/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile duct (IPNB) is a relatively rare disease and is known as one of the premalignant lesions in the biliary tract. The concept of IPNB has changed through numerous studies and is still evolving. As a lesser studied clinical entity compared with its pancreatic counterpart, intraductal papillary mucinous neoplasm, IPNB has been described in many similar terms, including biliary papillomatosis, biliary intraductal papillary-mucinous neoplasm, and papillary cholangiocarcinoma. This is based on the diversity of histopathological spectrum of IPNB. METHODS This review investigated previous studies including original articles, case studies, and expert opinions. Recently, two types of IPNB (types 1 and 2) have been proposed and validated based on the content first established in the WHO 2010 criteria. RESULTS This review provides a comprehensive analysis of existing literature, summarizing the clinical, radiological, morphological, and pathological characteristics of IPNB. CONCLUSION Given the ongoing ambiguity and controversies surrounding IPNB, future research, including large population-based studies and molecular investigations, is essential to enhance understanding of this disease.
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Affiliation(s)
- Jae Ri Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
- Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Kee-Taek Jang
- Department of Pathology and Translational Genomics, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul, Korea
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15
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Samar MR, Abbasi Z, Masood B, Zehra NE, Zaki A. Trick or Treat: An Intrahepatic Intraductal Papillary Neoplasm of the Bile Duct. Cureus 2023; 15:e43494. [PMID: 37719498 PMCID: PMC10500955 DOI: 10.7759/cureus.43494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
An intraductal papillary neoplasm involving the biliary tree is an unusual premalignant condition of epithelial origin, identified by its cystic dilatation of the biliary channels. Being a slow-growing tumor, surgery offers the best curative rate, especially in the setting of a low-grade disease. Here, we present a case of a localized, low-grade, intraductal papillary neoplasm of the bile duct (IPNB), residing in the liver, which was treated with resection of the liver lobe. The adjuvant treatment and prognosis highly depend upon the presence of dysplasia or a co-existent invasive malignancy. To the best of our knowledge, being a rare entity, this is the first case to be reported from Pakistan.
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Affiliation(s)
| | - Zainab Abbasi
- Medicine, Aga Khan University Hospital, Karachi, PAK
| | | | - Nida E Zehra
- Oncology, Aga Khan University Hospital, Karachi, PAK
| | - Adeeba Zaki
- Oncology, Aga Khan University Hospital, Karachi, PAK
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16
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Zhu X, Ni Q, Wang Q, Ma C, Yang F, Gao H, Zhu H, Zhou X, Chang H, Lu J, Liu F. Intraductal papillary mucinous neoplasm of the biliary tract in the caudate lobe of the liver: a case report and literature review. Front Oncol 2023; 13:1114514. [PMID: 37465111 PMCID: PMC10351580 DOI: 10.3389/fonc.2023.1114514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/15/2023] [Indexed: 07/20/2023] Open
Abstract
An intraductal papillary mucinous neoplasm of the biliary tract (BT-IPMN) in the caudate lobe of the liver is a rare tumor originating from the bile duct. Approximately 40% of the intraductal papillary neoplasms of the biliary tract (IPNB) secrete mucus and can grow in the intrahepatic or extrahepatic bile ducts. A 65-year-old woman presented with recurrent episodes of right upper pain. She developed her first episode 8 years ago, which resolved spontaneously. The frequency of symptoms has increased in the last 2 years. She underwent laparoscopic hepatectomy and choledochal exploration and was pathologically diagnosed with a rare BT-IPMN of the caudate lobe after admission. Here, we review studies on IPNB cases and systematically describe the pathological type, diagnosis, and treatment of IPNB to provide a valuable reference for hepatobiliary surgeons in the diagnosis and treatment of this disease.
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17
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Chan WH, Chen CM, Wang SY, Wu RC, Chen TC, Lee HK, Lin CH, Yeh CN. Intraductal papillary neoplasm of the bile duct presenting with hepatogastric fistula: a case report and literature review. Front Oncol 2023; 13:1193918. [PMID: 37274235 PMCID: PMC10237316 DOI: 10.3389/fonc.2023.1193918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Intraductal papillary neoplasm of the bile duct (IPNB) is an uncommon entity characterized by papillary growth within the bile duct lumen. IPNB is regarded as a biliary counterpart of intraductal papillary mucinous neoplasm of the pancreas, which sometimes complicates with fistula formation to adjacent organs, mainly due to high-pressure related erosion from mucin-filled ducts. However, fistula formation from IPNB is quite rare. Here we report a case of IPNB complicated with hepatogastric fistula. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed disproportional dilatation of left intrahepatic duct with intraluminal soft tissue nodules and fistulous connections to gastric high body. Endoscopy revealed ulcers with two fistulous orifices at upper gastric body. The patient underwent left hepatectomy with gastric wedge resection. Histopathology examination revealed IPNB with invasive cholangiocarcinoma, directly invading to gastric wall leading to hepatogastric fistula. In summary, we have presented the clinical, imaging and pathological findings, along with a comprehensive review of relevant literature, in order to enhance the understanding of this rare condition.
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Affiliation(s)
- Wen-Hui Chan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chien-Ming Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Tse-Ching Chen
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Hao-Kang Lee
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Hui Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
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18
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Wu RS, Liao WJ, Ma JS, Wang JK, Wu LQ, Hou P. Epidemiology and outcome of individuals with intraductal papillary neoplasms of the bile duct. World J Gastrointest Oncol 2023; 15:843-858. [PMID: 37275447 PMCID: PMC10237022 DOI: 10.4251/wjgo.v15.i5.843] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/16/2023] [Accepted: 03/16/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile duct (IPNB) is a rare distinct subtype of precursor lesions of biliary carcinoma. IPNB is considered to originate from luminal biliary epithelial cells, typically displays mucin-hypersecretion or a papillary growth pattern, and results in cystic dilatation[1]. IPNB develops anywhere in the intrahepatic and extrahepatic biliary tracts, and can occur in various pathological stages from low-grade dysplasia to invasive carcinoma. IPNBs have similar phenotypic changes in the occurrence and development of all subtypes, and the prognosis is significantly better than that of traditional (non-papillary) cholangiocarcinoma.
AIM To evaluate the clinicopathological features of IPNB to provide evidence-based guidance for treatment.
METHODS Invasive IPNB, invasive intraductal papillary mucinous neoplasm of the pancreas (IPMN), and traditional cholangiocarcinoma data for affected individuals from 1975 to 2016 were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Annual percentage changes (APCs) in the incidence and incidence-based (IB) mortality were calculated. We identified the independent predictors of overall survival (OS) and cancer-specific survival (CSS) in individuals with invasive IPNB.
RESULTS The incidence and IB mortality of invasive IPNB showed sustained decreases, with an APC of -4.5% (95%CI: -5.1% to -3.8%) and -3.3% (95%CI: -4.1% to -2.6%) (P < 0.001), respectively. Similar decreases in incidence and IB mortality were seen for invasive IPMN but not for traditional cholangiocarcinoma. Both OS and CSS for invasive IPNB were better than for invasive IPMN and traditional cholangiocarcinoma. A total of 1635 individuals with invasive IPNB were included in our prognosis analysis. The most common tumor sites were the pancreaticobiliary ampulla (47.9%) and perihilar tract (36.7%), but the mucin-related subtype of invasive IPNB was the main type, intrahepatically (approximately 90%). In the univariate and multivariate Cox regression analysis, age, tumor site, grade and stage, subtype, surgery, and chemotherapy were associated with OS and CSS (P < 0.05).
CONCLUSION Incidence and IB mortality of invasive IPNB trended steadily downward. The heterogeneity of IPNB comprises site and the tumor’s mucin-producing status.
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Affiliation(s)
- Rong-Shou Wu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
| | - Wen-Jun Liao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
| | - Jing-Sheng Ma
- Department of Organ Transplantation, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
| | - Jia-Kun Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
| | - Lin-Quan Wu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
| | - Ping Hou
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
- Department of General Surgery, The First Affiliated Hospital of Gannan Medical College, No. 23 Qingnian Road, Zhanggong District, Ganzhou 341000, Jiangxi Province, China
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19
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Xia Y, Guo H, Ma H. Hepatobiliary diseases. Eur J Intern Med 2023; 110:95-96. [PMID: 36635130 DOI: 10.1016/j.ejim.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Yuanhao Xia
- School of Medical Imaging, Binzhou Medical University, Yantai, China; Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, China
| | - Hao Guo
- Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, China
| | - Heng Ma
- School of Medical Imaging, Binzhou Medical University, Yantai, China; Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, China.
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20
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Lluís N, Serradilla-Martín M, Achalandabaso M, Jehaes F, Dasari BV, Mambrilla-Herrero S, Sparrelid E, Balakrishnan A, Hoogwater FJ, Amaral MJ, Andersson B, Berrevoet F, Doussot A, López-López V, Alsammani M, Detry O, Domingo-del Pozo C, Machairas N, Pekli D, Alcázar-López CF, Asbun H, Björnsson B, Christophides T, Díez-Caballero A, Francart D, Noel CB, Sousa-Silva D, Toledo-Martínez E, Tzimas GN, Yaqub S, Cauchy F, Prieto-Calvo M, D’Souza MA, Spiers HV, van den Heuvel MC, Charco R, Lesurtel M, Ramia JM. Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study). Int J Surg 2023; 109:760-771. [PMID: 36917142 PMCID: PMC10389541 DOI: 10.1097/js9.0000000000000280] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/19/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND/PURPOSE Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease in Western countries. The main aim of this study was to characterize current surgical strategies and outcomes in the mainly European participating centers. METHODS A multi-institutional retrospective series of patients with a diagnosis of IPNB undergoing surgery between 1 January 2010 and 31 December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association. The textbook outcome (TO) was defined as a non-prolonged length of hospital stay plus the absence of any Clavien-Dindo grade at least III complications, readmission, or mortality within 90 postoperative days. RESULTS A total of 28 centers contributed 85 patients who underwent surgery for IPNB. The median age was 66 years (55-72), 49.4% were women, and 87.1% were Caucasian. Open surgery was performed in 72 patients (84.7%) and laparoscopic in 13 (15.3%). TO was achieved in 54.1% of patients, reaching 63.8% after liver resection and 32.0% after pancreas resection. Median overall survival was 5.72 years, with 5-year overall survival of 63% (95% CI: 50-82). Overall survival was better in patients with Charlson comorbidity score 4 or less versus more than 4 ( P =0.016), intrahepatic versus extrahepatic tumor ( P =0.027), single versus multiple tumors ( P =0.007), those who underwent hepatic versus pancreatic resection ( P =0.017), or achieved versus failed TO ( P =0.029). Multivariable Cox regression analysis showed that not achieving TO (HR: 4.20; 95% CI: 1.11-15.94; P =0.03) was an independent prognostic factor of poor overall survival. CONCLUSIONS Patients undergoing liver resection for IPNB were more likely to achieve a TO outcome than those requiring a pancreatic resection. Comorbidity, tumor location, and tumor multiplicity influenced overall survival. TO was an independent prognostic factor of overall survival.
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Affiliation(s)
- Núria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Miguel Servet University Hospital, Zaragoza
| | - Mar Achalandabaso
- HPB Surgery and Transplantation, Hospital Universitario Vall d’Hebron
| | - François Jehaes
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Bobby V.M. Dasari
- Liver Transplant and HPB Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Ernesto Sparrelid
- Department of Clinical Science, Division of Surgery, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Anita Balakrishnan
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust
- Department of Surgery, University of Cambridge, Cambridge
| | - Frederik J.H. Hoogwater
- Department of HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria J. Amaral
- Department of General Surgery, Centro Hospitalar e Universitário de Coimbra
- Faculty of Medicine, University of Coimbra, Coimbra
| | - Bodil Andersson
- Department of Surgery, Lund University
- Skane University Hospital, Lund
| | - Frederik Berrevoet
- Department of General and HPB Surgery, and Liver Transplantation, University Hospital Gent, Gent
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, Besancon
| | - Víctor López-López
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, Murcia
| | | | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege
| | | | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens
| | - Damján Pekli
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Cándido F. Alcázar-López
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL)
| | - Horacio Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thalis Christophides
- General Surgery Department, HPB Division, Nicosia General Hospital, Nicosia, Cyprus
| | | | - David Francart
- Department of Abdominal Surgery, CHC Groupe Santé, Liège, Belgium
| | - Colin B. Noel
- HPB Clinical Unit, Gastrointestinal Surgery, Universitas Academic Hospital, University of the Free State, Bloemfontein
| | - Donzília Sousa-Silva
- Department of Surgery, HEBIPA – Hepatobiliary and Pancreatic Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Enrique Toledo-Martínez
- Servicio de Cirugía, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - George N. Tzimas
- Hepatobiliary Surgery Department, Hygeia Hospital, Athens, Greece
| | - Sheraz Yaqub
- Department of HPB Surgery, Oslo University Hospital
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - François Cauchy
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Mikel Prieto-Calvo
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao
| | - Melroy A. D’Souza
- Department of Clinical Science, Division of Surgery, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Harry V.M. Spiers
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust
- Department of Surgery, University of Cambridge, Cambridge
| | - Marius C. van den Heuvel
- Department of HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ramón Charco
- HPB Surgery and Transplantation, Hospital Universitario Vall d’Hebron
| | - Mickaël Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - José M. Ramia
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL)
- Miguel Hernández University, Alicante
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21
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Wu X, Li B, Zheng C. Clinicopathologic characteristics and long-term prognosis of intraductal papillary neoplasm of the bile duct: a retrospective study. Eur J Med Res 2023; 28:132. [PMID: 36945047 PMCID: PMC10029268 DOI: 10.1186/s40001-023-01102-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 03/17/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile duct (IPNB) is a premalignant neoplasm that can involve both the intrahepatic and extrahepatic bile ducts. Owing to the low incidence and confusing nomenclature, its clinicopathological features remain controversial. Additionally, only a few studies have reported on the long-term prognosis of IPNB to date. Therefore, the present study aimed to clarify the clinicopathological characteristics and prognosis of IPNB. METHODS Medical records of patients with IPNB treated at our hospital between August 2000 and October 2021 were retrospectively reviewed. A database of demographic characteristics, test results, surgical details, pathological findings, and follow-up information was constructed for analysis. Patients were divided into intrahepatic and extrahepatic groups, and dysplasia and invasive carcinoma groups for comparison. Differences between study groups were analyzed using the χ2 test, Fisher's exact test, t-test, or Mann-Whitney U test, as appropriate. Cumulative survival rates were estimated using the Kaplan-Meier method. RESULTS In total, 43 patients (21 men and 22 women) with IPNB were included in the study. The median age at diagnosis was 62 (54-69) years. Thirty-eight patients underwent surgery. The mean operation time was (269.5 ± 94.9) min. Five patients underwent endoscopic retrograde cholangiopancreatography for biopsy. Twenty-one and 22 patients had intrahepatic and extrahepatic lesions, respectively. The extrahepatic group had more patients with intraluminal masses (p = 0.021) and abnormal bilirubin levels (p = 0.001), but fewer patients with hepatolithiasis (p = 0.021). The operation time was longer in patients with extrahepatic lesions (p = 0.002). Twenty patients had dysplasia and 23 had invasive carcinoma. The invasive carcinoma group had a longer operation time than the dysplasia group (p = 0.004). As of March 2022, 39 patients were followed up, with a mean follow-up time of (56.2 ± 38.2) months. Fifteen patients survived without tumors, two survived with tumors, and 22 patients died. The 1-, 3-, 5-, and 10-year cumulative overall survival rates were 86.9%, 65.8%, 49.8%, and 32.0%, respectively. CONCLUSIONS IPNB is a rare bile duct disease that occurs mainly in patients with advanced age. Surgery is the primary treatment strategy. Intrahepatic and extrahepatic lesions, as well as dysplasia and invasive carcinoma have their own unique characteristics. The long-term prognosis of IPNB is generally poor.
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Affiliation(s)
- Xin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Binglu Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Chaoji Zheng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
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22
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Yaghnam I, Syed N, Peng J, Moyer M. Endoscopic treatment of a large intraductal papillary mucinous neoplasm of the bile duct: tips and tricks learned during multiple treatments of a difficult case. VideoGIE 2023; 8:141-143. [PMID: 37095840 PMCID: PMC10122117 DOI: 10.1016/j.vgie.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Video 1Endoscopic video demonstrating the ability to gain access to the biliary system using the rigidizing overtube, and subsequent attempted EMR of the neoplastic lesion, followed by successful APC with complete ablation of the neoplasm.
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23
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Anné F, Snauwaert C, Vandeputte L, Berrevoet F, Van Huysse J, Van Dorpe J, Hoorens A. The added value of peroral cholangioscopy to diagnose intraductal papillary neoplasm of the bile duct. Endoscopy 2022; 54:E759-E760. [PMID: 35477119 DOI: 10.1055/a-1792-2395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Florence Anné
- Ghent University Faculty of Medicine and Health Sciences, Department of Hepatology and Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Christophe Snauwaert
- Department of Hepatology and Gastroenterology, AZ Sint-Jan Bruges-Ostend AV, Bruges, Belgium
| | - Lieven Vandeputte
- Department of Hepatology and Gastroenterology, AZ Sint-Jan Bruges-Ostend AV, Bruges, Belgium
| | - Frederik Berrevoet
- Department of General and Hepatobiliary Surgery, Ghent University Hospital, Ghent, Belgium
| | | | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Anne Hoorens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
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24
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Li B, Liu Z, Meng Z, Li M, Tian W, Liu Q. Surgical Treatment of Intraductal Papillary Neoplasm of the Bile Duct: A Report of Two Cases and Review of the Literature. Front Oncol 2022; 12:916457. [PMID: 35814451 PMCID: PMC9259795 DOI: 10.3389/fonc.2022.916457] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Intraductal papillary neoplasm of the bile duct (IPNB) is a rare bile duct tumor characterized by intraductal papillary or villous neoplasms covered by neoplastic epithelium with fine fibrovascular stalks in the dilated bile ducts (1). Its true etiology remains unknown. Herein, we report two cases of IPNB that underwent surgical resection. The first case was a 66-year-old male who complained of upper abdominal pain for three years. We found obstruction of the common bile duct and dilation of the intrahepatic and extrahepatic bile ducts after MRCP. Laparoscopic hepatic segmentectomy (S2, S3, S4), resection of the common bile duct, cholecystectomy, and hepaticojejunostomy were performed. The second case was a 67-year-old male with asymptomatic dilation of the intrahepatic duct. The patient underwent robot-assisted laparoscopic hepatic segmentectomy (S5, S6, S7, S8), resection of the common bile duct, hepaticojejunostomy and cholecystectomy.
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25
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Pandey S, Agarwal N, Gupta V, Sharma A, Aggarwal A, Gupta S, Krishan R. Diagnosing rare intraductal biliary neoplasms – Intraductal papillary neoplasm of the bile duct: A case report with typical imaging findings. SA J Radiol 2022; 26:2387. [PMID: 35548709 PMCID: PMC9082281 DOI: 10.4102/sajr.v26i1.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
Intraductal papillary neoplasm of the bile duct (IPN-B) is a rare preinvasive intraductal pathology of the biliary tract. It should be differentiated from other more common benign or malignant causes of biliary obstruction and dilatation such as calculi or cholangiocarcinoma because the management and prognosis of this condition differs significantly. This case report describes a case of IPN-B in a 45-year-old female patient who presented with non-specific complaints of chronic abdominal pain without jaundice for three months.
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Affiliation(s)
- Saumya Pandey
- Department of Radiodiagnosis, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Nitin Agarwal
- Department of Radiodiagnosis, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Vidushi Gupta
- Department of Radiodiagnosis, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Ashok Sharma
- Department of Radiodiagnosis, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Anil Aggarwal
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Sunita Gupta
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Ram Krishan
- Department of Pathology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
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26
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Fukuya H, Kuwano A, Nagasawa S, Morita Y, Tanaka K, Yada M, Masumoto A, Motomura K. Multicentric recurrence of intraductal papillary neoplasm of bile duct after spontaneous detachment of primary tumor: A case report. World J Clin Cases 2022; 10:1000-1007. [PMID: 35127913 PMCID: PMC8790441 DOI: 10.12998/wjcc.v10.i3.1000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/07/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile duct (IPNB) rarely recurs in a multicentric manner. We encountered a patient with multiple recurrences of the gastric subtype of IPNB one year after spontaneous detachment of the primary tumor during peroral cholangioscopy (POCS).
CASE SUMMARY A 68-year-old woman on maintenance hemodialysis because of lupus nephritis had several cardiovascular diseases and a pancreatic intraductal papillary mucinous neoplasm (IPMN). She was referred to our department for dilation of the common bile duct (CBD) and a tumor in the lumen, detected using ultrasonography. She had no complaints, and blood tests of hepatobiliary enzymes were normal. Magnetic resonance cholangiopancreatography (MRCP) showed a papillary tumor in the CBD with a filling defect detected using endoscopic retrograde cholangiography (ERC). Intraductal ultrasonography revealed a papillary tumor and stalk at the CBD. During POCS, the tumor spontaneously detached with its stalk into the CBD. Pathology showed low-intermediate nuclear atypia of the gastric subtype of IPNB. After 1 year, follow-up MRCP showed multiple tumors distributed from the left hepatic duct to the CBD. ERC and POCS showed multicentric tumors. She was alive without hepatobiliary symptoms at least two years after initial diagnosis of IPNB.
CONCLUSION The patient experienced gastric subtype of IPNB without curative resection. Observation may be reasonable for patients with this subtype.
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Affiliation(s)
- Hiroki Fukuya
- Department of Hepatology, Iizuka Hospital, Iizuka 820-8505, Fukuoka, Japan
| | - Akifumi Kuwano
- Department of Hepatology, Iizuka Hospital, Iizuka 820-8505, Fukuoka, Japan
| | - Shigehiro Nagasawa
- Department of Hepatology, Iizuka Hospital, Iizuka 820-8505, Fukuoka, Japan
| | - Yusuke Morita
- Department of Hepatology, Iizuka Hospital, Iizuka 820-8505, Fukuoka, Japan
| | - Kosuke Tanaka
- Department of Hepatology, Iizuka Hospital, Iizuka 820-8505, Fukuoka, Japan
| | - Masayoshi Yada
- Department of Hepatology, Iizuka Hospital, Iizuka 820-8505, Fukuoka, Japan
| | - Akihide Masumoto
- Department of Hepatology, Iizuka Hospital, Iizuka 820-8505, Fukuoka, Japan
| | - Kenta Motomura
- Department of Hepatology, Iizuka Hospital, Iizuka 820-8505, Fukuoka, Japan
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27
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Takasaki T, Sakamoto T, Saito A, Motomura Y. Intraductal papillary neoplasm of bile duct with invasive carcinoma as an intrahepatic cystic lesion, with successful preoperative diagnosis. BMJ Case Rep 2022; 15:e245918. [PMID: 34996768 PMCID: PMC8744093 DOI: 10.1136/bcr-2021-245918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/03/2022] Open
Abstract
An 82-year-old man presented to the emergency department with abdominal pain and febrile symptoms that had been present for 4 days. Blood tests showed elevated liver enzymes and white blood cell count, and abdominal contrast-enhanced CT revealed a 35 mm cystic lesion in the left lateral liver lobe. On closer examination, the cystic lesion was found to have contiguous bile duct dilatation and internal nodules. Furthermore, mucus production was observed during endoscopic retrograde cholangiopancreatography, which led to the diagnosis of intraductal papillary neoplasm of the bile duct (IPNB), with cystic infection. Although the patient was an older adult, there was no background disease that would have prevented surgery, and resection was performed. Pathological examination revealed type 1 IPNB, with invasive carcinoma. The number of reports of IPNB is expected to increase with an increasing older population in Asia, and we report the findings of this case.
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Affiliation(s)
- Tetsuro Takasaki
- Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Iryo Center, Urayasu, Chiba, Japan
| | - Takashi Sakamoto
- Department of Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Akira Saito
- Department of Pathology, Tokyo Bay Urayasu Ichikawa Iryo Center, Urayasu, Chiba, Japan
| | - Yasuaki Motomura
- Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Iryo Center, Urayasu, Chiba, Japan
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28
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Tang Y, Wang C, Fu S, Li T, He G. Intrahepatic Biliary Cystadenoma With Colonic Adenomatous Polyps in a Patient With Chronic Hepatitis B: A Case Report and Literature Review. Front Med (Lausanne) 2021; 8:760607. [PMID: 34977067 PMCID: PMC8716544 DOI: 10.3389/fmed.2021.760607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/25/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Biliary cystadenomas are rare cystic tumors of the bile duct system that are mostly benign but also have the possibility of malignant transformation. Biliary cystadenomas mostly occur in the intrahepatic bile ducts and are more common in middle-aged women. Due to non-specific radiology, preoperative diagnosis is difficult and is usually performed by postoperative pathology. Complete resection is the best treatment option, and the postoperative prognosis is good.Case Description: This study reports a case of a patient with biliary cystadenoma who was diagnosed with simultaneous chronic hepatitis B and colon (hepatic flexure) adenomatous polyps. The patient presented to the doctor because of abdominal pain, and a blood test showed hepatitis B. Computed tomography revealed both right liver and colonic lesions. Colonoscopy revealed polyps, and the postoperative pathological diagnosis was adenomatous polyps. Laparoscopic resection of the right liver tumor was performed, and it was diagnosed as hepatobiliary cystadenoma by postoperative pathological analysis combined with immunohistochemistry.Conclusion: In patients with chronic hepatitis, the shape of biliary cystadenoma may not be very typical, and it is necessary to combine this with immunohistochemistry for diagnosis. When multiple lesions are detected in the painful area, the diagnosis of each lesion and its treatment sequence are worthy of consideration. Under normal circumstances, the prognosis of biliary cystadenoma is good; however, in patients with chronic hepatitis B, more cases need to be observed for verification.
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Affiliation(s)
- Yan Tang
- The Remarkable and Innovation Class, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Chenyu Wang
- The Remarkable and Innovation Class, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shunjun Fu
- Department of Hepatobiliary Surgery II, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ting Li
- Department of Hepatobiliary Surgery II, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Ting Li
| | - Guolin He
- Department of Hepatobiliary Surgery II, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Guolin He
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29
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Lee MH, Katabathina VS, Lubner MG, Shah HU, Prasad SR, Matkowskyj KA, Pickhardt PJ. Mucin-producing Cystic Hepatobiliary Neoplasms: Updated Nomenclature and Clinical, Pathologic, and Imaging Features. Radiographics 2021; 41:1592-1610. [PMID: 34597230 DOI: 10.1148/rg.2021210011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cystic hepatobiliary neoplasms with mucin-producing epithelium-mucinous cystic neoplasm of the liver (MCN) and intraductal papillary neoplasm of the bile duct (IPNB)-are rare and distinct entities that have unique clinical, pathologic, and imaging features. They are differentiated pathologically by the presence of subepithelial ovarian-like hypercellular stroma (OLS), which is the defining histopathologic feature of MCN. MCN is commonly a benign, large, solitary, symptomatic, multiloculated cystic mass without biliary communication that occurs in middle-aged women. On the other hand, IPNBs are a heterogeneous spectrum of tumors, which are commonly associated with invasive carcinoma, occur in older patients, and can be differentiated from MCN by communication with the biliary tree, intraductal masses, associated biliary ductal dilatation, and absent OLS. Understanding of these rare neoplasms has grown and evolved over time and continues to today, but uncertainty and controversy persist, related to the rarity of these tumors, relatively recent designation as separate entities, inherent clinicopathologic heterogeneity, overlapping imaging features, and the fact that many prior studies likely included MCN and cystic IPNB together as a single entity. Confusion regarding these neoplasms is evident by historical inconsistencies and nonstandardized nomenclature through the years. Awareness of these entities is important for the interpreting radiologist to suggest a particular diagnosis or generate a meaningful differential diagnosis in the appropriate setting, and is of particular significance as MCN and cystic IPNB have overlapping imaging features with other more common hepatobiliary cystic masses but have different management and prognosis. Online supplemental material is available for this article. Work of the U.S. Government published under an exclusive license with the RSNA.
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Affiliation(s)
- Matthew H Lee
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Venkata S Katabathina
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Meghan G Lubner
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Hardik U Shah
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Srinivasa R Prasad
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Kristina A Matkowskyj
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
| | - Perry J Pickhardt
- From the Department of Radiology, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (M.H.L.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); Departments of Radiology (M.G.L., P.J.P.) and Pathology (K.A.M.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (H.U.S.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.)
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30
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Onoe S, Ebata T, Yokoyama Y, Igami T, Mizuno T, Yamaguchi J, Watanabe N, Otsuka S, Nakamura S, Shimoyama Y, Nagino M. A clinicopathological reappraisal of intraductal papillary neoplasm of the bile duct (IPNB): a continuous spectrum with papillary cholangiocarcinoma in 181 curatively resected cases. HPB (Oxford) 2021; 23:1525-1532. [PMID: 33832834 DOI: 10.1016/j.hpb.2021.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/28/2021] [Accepted: 03/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile-duct (IPNB) has recently been further subclassified into "so-called IPNBs" (Type-1) and "narrow-sense papillary cholangiocarcinomas" (Type-2), but their differential diagnosis is challenging. This study aimed to reevaluate Type-1 and Type-2 IPNBs. METHODS Consecutive patients who underwent papillary bile-duct tumor resection were included. Using six pathological features (location, mucin secretion, histological architecture, histological type, presence of a low/intermediate-dysplasia component, and proportion of the invasive component), all papillary tumors were scored. Tumors scoring 5-6 were classified as Type-1, 0-1 as Type-2, and 2-4 as Type-Unclassifiable. RESULTS The 181 papillary bile-duct tumor patients were divided into three groups, consisting of 12 Type-1, 46 Type-2, and 123 Type-Unclassifiable-gray-zone lesions between Type-1 and Type-2 that constituted the largest proportion of papillary tumors. Type-1 tumors were pathologically the least advanced, while the other types showed gradual advancement. The 5-year survival rate was better for patients with Type-1 tumors than for those with Type-Unclassifiable or Type-2 tumors. CONCLUSION The scoring system worked well to delineate a continuous spectrum of pathologic features ranging from Type-1, through Type-Unclassifiable, to Type-2, the latter two being challenging to differentially diagnose. Type-1 is regarded as an early neoplasm of Type-Unclassifiable and Type-2.
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Affiliation(s)
- Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinpei Otsuka
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeo Nakamura
- Department of Pathology and Clinical Laboratories, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshie Shimoyama
- Department of Pathology and Clinical Laboratories, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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31
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Usui A, Ohta Y, Nishimori T, Kuroda H, Shinohara Y, Sakamoto A. Intraductal papillary neoplasm of the bile duct presenting as multiple pedunculated polyps in the common bile duct at the cystic duct confluence: A case report. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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32
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Rompianesi G, Di Martino M, Gordon-Weeks A, Montalti R, Troisi R. Liquid biopsy in cholangiocarcinoma: Current status and future perspectives. World J Gastrointest Oncol 2021; 13:332-350. [PMID: 34040697 PMCID: PMC8131901 DOI: 10.4251/wjgo.v13.i5.332] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/02/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Abstract
Cholangiocarcinoma (CCA) are a heterogeneous group of tumors in terms of aetiology, natural history, morphological subtypes, molecular alterations and management, but all sharing complex diagnosis, management, and poor prognosis. Several mutated genes and epigenetic changes have been detected in CCA, with the potential to identify diagnostic and prognostic biomarkers and therapeutic targets. Accessing tumoral components and genetic material is therefore crucial for the diagnosis, management and selection of targeted therapies; but sampling tumor tissue, when possible, is often risky and difficult to be repeated at different time points. Liquid biopsy (LB) represents a way to overcome these issues and comprises a diverse group of methodologies centering around detection of tumor biomarkers from fluid samples. Compared to the traditional tissue sampling methods LB is less invasive and can be serially repeated, allowing a real-time monitoring of the tumor genetic profile or the response to therapy. In this review, we analysis the current evidence on the possible roles of LB (circulating DNA, circulating RNA, exosomes, cytokines) in the diagnosis and management of patients affected by CCA.
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Affiliation(s)
- Gianluca Rompianesi
- Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Napoli 80131, Italy
| | - Marcello Di Martino
- Hepato-Bilio-Pancreatic Surgery Unit, Department of General and Digestive Surgery, Hospital Universitario La Princesa, Madrid 28006, Spain
| | - Alex Gordon-Weeks
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Roberto Montalti
- Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Napoli 80131, Italy
| | - Roberto Troisi
- Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Napoli 80131, Italy
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Krawczyk M, Ziarkiewicz-Wróblewska B, Podgórska J, Grzybowski J, Gierej B, Krawczyk P, Grąt M, Kornasiewicz O, Skalski M, Wróblewski T. Intraductal papillary neoplasm of the bile duct - A comprehensive review. Adv Med Sci 2021; 66:138-147. [PMID: 33556909 DOI: 10.1016/j.advms.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/14/2020] [Accepted: 01/21/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile ducts is a rare tumor type. Management decisions are currently based upon a small case series. The authors have large own experience with IPNB. OBJECTIVE The review aims at reporting on clinicopathological features of IPNB in order to provide guidance for management. METHODS We searched PubMed, Medline, Microsoft Academic and Embase databases to identify studies of relevance. The analysis of own experience was also included. RESULTS We analyzed 59 retrospective series and 25 cases from authors' clinical experience. The main sign was jaundice and cholangitis, 33% and 48%, respectively. CT's were performed in 63-76% and MR in 40-56%. Intraductal mass was found in 31-32% and duct dilatation in 27-30%. Endoscopic Retrograde Cholangio-Pancreatography (ERCP) was performed in 48-62%. IPNB with invasive carcinoma was found in 35.7-60% and IPNB with intraepithelial neoplasia in 36-60%. Histopathological confirmation before surgery was rare. The main treatment of IPNB is resection, in our material, both, hepatectomy and hepatectomy plus bile duct resections were performed in 40% of patients. The percentage of postoperative complications was 20%. The 5-year survival rate of all IPNB's patients was 53.6%; in patients with associated invasive carcinoma - 22.2% and without invasive carcinoma - 100% (p = 0.001). CONCLUSIONS Early surgery is advisable for radiologically suspected IPNB. The results of treatment depend on histopathology. They are worse at intraductal invasive carcinoma than at neoplasm with neoplasia.
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Xiao M, Sun A, Yu F, Xiao Y, Li L, Shen D, Xiang C, Dong J. Intraductal papillary neoplasm of intrahepatic bile ducts complicated by chronic disseminated intravascular coagulation and thrombosis: A case report. Medicine (Baltimore) 2021; 100:e24454. [PMID: 33592896 PMCID: PMC7870212 DOI: 10.1097/md.0000000000024454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/06/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Intraductal papillary neoplasm of the bile ducts (IPNB) is a relatively rare tumor that is clinically characterized by digestive symptoms. The concurrent occurrence of chronic disseminated intravascular coagulation (DIC) with thrombosis is an extremely rare combination, reported in patients with IPNB. The clinical features of chronic DIC include microangiopathic hemolytic anemia, thrombocytopenia, and hypofibrinogenemia. Here, we report the case of a mucin-producing IPNB patient with hematological abnormalities. PATIENT CONCERNS A 58-year-old male patient suffered from abdominal distension for more than 2 months with obstructive jaundice appearance. Abdominal contrast-enhanced computed tomography and magnetic resonance cholangiopancreatography showed a neoplasm in the right hepatic lobe. Multiple intravascular fillings were found in the inferior vena cava, pulmonary artery, and right atrium. Anemia and hypofibrinogenemia were discovered through routine laboratory tests. The count of platelets began to decline 25 days after admission, while 1 month after hospitalization, the patient developed abdominal pain, fever, and shock. DIAGNOSIS Pathological examination demonstrated IPNB with a part of high-grade intraepithelial neoplasia. Cardiac and inferior vena cava emboli were diagnosed as thrombi without neoplastic cells. Immunohistochemically, tumor cells were positive for Vimentin (mesenchyme), CK7, CK19, MUC-1, MUC-5AC, MUC-6, S-100p (focal), Ki-67 (12%), and negative for Inhibin-α, ER, CK20, CEA, and MUC-2. Additionally, immunohistochemistry indicated that IPNB was a mucus-secretion gastric type. The laboratory tests confirmed the presence of chronic DIC. INTERVENTIONS The patient was given anticoagulant therapy before hepatectomy and right atrium thrombectomy was performed under cardiopulmonary bypass. OUTCOMES After anticoagulant therapy, the levels of hemoglobin, platelet, and fibrinogen of the patient returned to normal. Hepatectomy and thrombus removal was successfully performed. Then, the patient was discharged 12 days after the operation. After 12 months of follow-up, the patient recovered well without any hematologic abnormalities and no signs of tumor recurrence were observed. LESSONS IPNB may cause hematological complications, which can be easily misdiagnosed. It is essential to pay particular attention to the hematological abnormalities of patients with IPNB. Early detection and differential diagnosis of chronic DIC and thrombosis are necessary. We note that anticoagulant therapy coupled with surgery is an effective strategy to treat these complications.
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Affiliation(s)
- Ming Xiao
- Center of Hepatopancreatobiliary Diseases
| | - Aijun Sun
- Department of Hepatobiliary Surgery, Zhucheng People's Hospital, Zhucheng, China
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Ramzi J, Feretis M, Hickman KE, Martin JL, Godfrey E, Liau SS. Preoperative diagnosis of intraductal papillary neoplasm of the bile duct with endoscopic ultrasound. Ann R Coll Surg Engl 2021; 103:e65-e68. [PMID: 33559545 PMCID: PMC9773918 DOI: 10.1308/rcsann.2020.7010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intraductal papillary mucinous neoplasm of the bile duct is a rare tumour only recently classified as a distinct pathological entity. These neoplasms, rarely encountered in clinical practice in the UK, are now considered to be important precursors for the development of cholangiocarcinoma. We present a histologically confirmed case of intraductal papillary neoplasm of the bile duct in a male patient and discuss the main radiographic manifestations of this rare condition across multiple imaging modalities, with an emphasis on the imaging features of endoscopic ultrasonography and its role in establishing the diagnosis.
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Affiliation(s)
- J Ramzi
- Hepatopancreatobiliary Surgical Unit, Addenbrooke's Hospital, Biomedical Campus, Cambridge, UK
| | - M Feretis
- Hepatopancreatobiliary Surgical Unit, Addenbrooke's Hospital, Biomedical Campus, Cambridge, UK
| | - KE Hickman
- Department of Radiology, Addenbrooke's Hospital, Biomedical Campus, Cambridge, UK
| | - JL Martin
- Hepatopancreatobiliary Surgical Unit, Addenbrooke's Hospital, Biomedical Campus, Cambridge, UK
| | - E Godfrey
- Department of Radiology, Addenbrooke's Hospital, Biomedical Campus, Cambridge, UK
| | - SS Liau
- Hepatopancreatobiliary Surgical Unit, Addenbrooke's Hospital, Biomedical Campus, Cambridge, UK
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Tomita H, Tanaka K, Hirata A, Okada H, Imai H, Shirakami Y, Ohnishi K, Sugie S, Aoki H, Hatano Y, Noguchi K, Kanayama T, Niwa A, Suzui N, Miyazaki T, Tanaka T, Akiyama H, Shimizu M, Yoshida K, Hara A. Inhibition of FGF10-ERK signal activation suppresses intraductal papillary neoplasm of the bile duct and its associated carcinomas. Cell Rep 2021; 34:108772. [PMID: 33626352 DOI: 10.1016/j.celrep.2021.108772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/31/2020] [Accepted: 01/28/2021] [Indexed: 02/07/2023] Open
Abstract
Evidence regarding intraductal papillary neoplasm of the bile duct (IPNB) as a type of precancerous lesion of cholangiocarcinoma is limited. Moreover, a reproducible in vivo model is lacking, and IPNB pathogenesis remains unclear. Here, we use a doxycycline-inducible tetracycline (Tet)-on mice model to control fibroblast growth factor 10 (FGF10) expression, which regulates branching and tubule formation. FGF10-induced IPNB mimics the multifocal and divergent human IPNB phenotypes via the FGF10-FGF receptor 2 (FGFR2)-RAS-extracellular-signal-regulated kinase (ERK) signaling pathway. A paracrine/autocrine growth factor is sufficient to initiate and maintain IPNB originating from the peribiliary glands, including biliary stem/progenitor cells. With KrasG12D, p53, or p16 mutations or both, Fgf10-induced IPNB shows stepwise carcinogenesis, causing associated invasive carcinoma. Fgf10-induced papillary changes and progression are suppressed by the inhibition of the FGF10-FGFR2-RAS-ERK signaling pathway, demonstrating that the signal is a therapeutic target for IPNB and associated carcinoma.
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Affiliation(s)
- Hiroyuki Tomita
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.
| | - Kaori Tanaka
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan; Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Akihiro Hirata
- Division of Animal Experiment, Life Science Research Center, Gifu University, Gifu 501-1194, Japan
| | - Hideshi Okada
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Hisashi Imai
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Yohei Shirakami
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Kotaro Ohnishi
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Shigeyuki Sugie
- Department of Pathology, Asahi University Hospital, Gifu 500-8523, Japan
| | - Hitomi Aoki
- Department of Tissue and Organ Development, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Yuichiro Hatano
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Kei Noguchi
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Tomohiro Kanayama
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Ayumi Niwa
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Natsuko Suzui
- Department of Pathology, Gifu University Hospital, Gifu 501-1194, Japan
| | | | - Takuji Tanaka
- Department of Diagnostic Pathology (DDP) and Research Center of Diagnostic Pathology (RC-DiP), Gifu Municipal Hospital, Gifu 500-8513, Japan
| | - Haruhiko Akiyama
- Department of Orthopedic Surgery, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Masahito Shimizu
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Akira Hara
- Department of Tumor Pathology, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
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Reappraisal of pathological features of intraductal papillary neoplasm of bile duct with respect to the type 1 and 2 subclassifications. Hum Pathol 2021; 111:21-35. [PMID: 33508254 DOI: 10.1016/j.humpath.2021.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/14/2022]
Abstract
The pathological spectrum of intraductal papillary neoplasm of bile duct (IPNB) remains to be clarified. A total of 186 IPNBs were pathologically examined using the type 1 and 2 subclassifications proposed by Japanese and Korean biliary pathologists incorporating a two-tiered grading system (low-grade and high-grade dysplasia), with reference to four subtypes (intestinal [i], gastric [g], pancreatobiliary [pb], and concocytic [o] subtype). IPNBs were classifiable into type 1 composed of low-grade dysplasia and 'high-grade dysplasia with regular structures' (69 IPNBs), and type 2 of 'high grade dysplasia with irregular structures and complicated lesions' (117 IPNBs). Type 1 was more common in the intrahepatic bile duct (78%), whereas type 2 was frequently located in the extrahepatic bile duct (58%). Mucin hypersecretion was more common in type 1 (61%) than in type 2 (37%). IPNBs were classifiable into the four subtypes: 86 iPNBs, 40 gIPNBs, 31 pbIPNBs, and 29 oIPNBs. The four subtypes were histologically evaluable with reference to the type 1 and 2 subclassifications. iIPNB and pbIPNBs were frequently classified as type 2, whereas types 1 and 2 were observed at similar rates in gIPNB and oIPNB. Stromal invasion was almost absent in type 1, irrespective of subtype, but was found in 66 of 117 type 2 IPNBs (P < .01), and postoperative outcome was favorable in IPNBs without invasion compared with IPNBs with invasion (P < .05). The type 1 and 2 subclassifications with reference to the four subtypes may provide useful information for understanding IPNB.
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Shyu S, Singhi AD. Cystic biliary tumors of the liver: diagnostic criteria and common pitfalls. Hum Pathol 2020; 112:70-83. [PMID: 33383041 DOI: 10.1016/j.humpath.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023]
Abstract
With major advancements and frequent use of abdominal imaging techniques, hepatic cysts are increasingly encountered in clinical practice. Although the majority of cysts are benign, a small subset represents neoplastic precursors to cholangiocarcinoma. These cystic precursors include intraductal papillary neoplasms of the bile duct (IPNB) and mucinous cystic neoplasms of the liver (MCN-L), and bear striking pathologic resemblance to corresponding cystic neoplastic precursors within the pancreas. This review examines the salient clinical, gross, microscopic and molecular features of IPNBs and MCN-Ls, and, in particular, provides histopathologic comparison to their pancreatic counterparts. Considering these neoplasms may be diagnostically challenging, we also discuss other hepatic lesions within the differential diagnosis, and the potential for molecular methods to improve their preoperative evaluation and the early detection of cholangiocarcinoma.
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Affiliation(s)
- Susan Shyu
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Aatur D Singhi
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Intraductal Papillary Neoplasm of Bile Duct: Updated Clinicopathological Characteristics and Molecular and Genetic Alterations. J Clin Med 2020; 9:jcm9123991. [PMID: 33317146 PMCID: PMC7763595 DOI: 10.3390/jcm9123991] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023] Open
Abstract
Intraductal papillary neoplasm of the bile duct (IPNB), a pre-invasive neoplasm of the bile duct, is being established pathologically as a precursor lesion of invasive cholangiocarcinoma (CCA), and at the time of surgical resection, approximately half of IPNBs show stromal invasion (IPNB associated with invasive carcinoma). IPNB can involve any part of the biliary tree. IPNB shows grossly visible, exophytic growth in a dilated bile duct lumen, with histologically villous/papillary neoplastic epithelia with tubular components covering fine fibrovascular stalks. Interestingly, IPNB can be classified into four subtypes (intestinal, gastric, pancreatobiliary and oncocytic), similar to intraductal papillary mucinous neoplasm of the pancreas (IPMN). IPNBs are classified into low-grade and high-grade based on lining epithelial features. The new subclassification of IPNB into types 1 (low-grade dysplasia and high-grade dysplasia with regular architecture) and 2 (high-grade dysplasia with irregular architecture) proposed by the Japan–Korea pathologist group may be useful in the clinical field. The outcome of post-operative IPNBs is more favorable in type 1 than type 2. Recent genetic studies using next-generation sequencing have demonstrated the existence of several groups of mutations of genes: (i) IPNB showing mutations in KRAS, GNAS and RNF43 belonged to type 1, particularly the intestinal subtype, similar to the mutation patterns of IPMN; (ii) IPNB showing mutations in CTNNB1 and lacking mutations in KRAS, GNAS and RNF43 belonged to the pancreatobiliary subtype but differed from IPMN. IPNB showing mutation of TP53, SMAD4 and PIK3CA might reflect complicated and other features characterizing type 2. The recent recognition of IPNBs may facilitate further clinical and basic studies of CCA with respect to the pre-invasive and early invasive stages.
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Fujino R, Masuoka Y, Mashiko T, Nakano A, Hirabayashi K, Nakagohri T. Lung metastases from intraductal papillary neoplasm of the bile duct: a case report. World J Surg Oncol 2020; 18:271. [PMID: 33097064 PMCID: PMC7585296 DOI: 10.1186/s12957-020-02054-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/15/2020] [Indexed: 12/02/2022] Open
Abstract
Background Intraductal papillary neoplasm of the bile duct (IPNB) is considered a pre-cancerous biliary lesion and/or an early cancer lesion, although its classification remains unclear. The 2019 revised edition of the World Health Organization Classification of Tumors of the Digestive System proposed type 1 and type 2 as new classification categories, and meta-analyses and/or multi-center cohort studies are beginning to be reported. However, treatment for IPNB recurrence and metastasis remains unclear. Case presentation A 60-year-old man who was referred to our hospital after a suspected liver tumor was diagnosed using abdominal ultrasonography. Imaging findings revealed an irregularly shaped tumor in segment 5 (S5) of the liver (size 20 mm). The S5 lesion was suspected as IPNB, and segmentectomy was performed. The pathological findings revealed invasive carcinoma derived from IPNB, and immunohistochemistry revealed positive expression of MUC1, MUC5AC, and MUC6, but negative expression of CDX2 and MUC2. At 9 months after the surgery, computed tomography revealed a tumor in the right bile duct, which was diagnosed as liver recurrence of IPNB, and right hepatectomy was performed. The histopathological findings were the same as for the first resected specimen (i.e., IPNB). At 45 months after the second surgery, computed tomography revealed nodules in both lungs, which were diagnosed as lung metastases from IPNB and resected in two separate procedures. The pathological findings were metastatic carcinoma from IPNB for both lung lesions. The patient is currently alive and undergoing adjuvant chemotherapy (S-1), which was initiated 64 months after the first resection and 12 months after resection of the lung metastases. Conclusion We encountered a rare case of lung metastases from IPNB, which were diagnosed immunohistologically. Because IPNB is generally a slow-growing tumor, resection may be feasible for IPNB recurrence and/or metastasis, which may be detected during long-term follow-up. Thus, even if resection is performed for primary IPNB, additional surgical treatment may be feasible in this setting.
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Affiliation(s)
- Rika Fujino
- Department of Surgery, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 2591193, Japan
| | - Yoshihito Masuoka
- Department of Surgery, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 2591193, Japan.
| | - Taro Mashiko
- Department of Surgery, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 2591193, Japan
| | - Akira Nakano
- Department of Surgery, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 2591193, Japan
| | - Kenichi Hirabayashi
- Department of Pathology, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 2591193, Japan
| | - Toshio Nakagohri
- Department of Surgery, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa, 2591193, Japan
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Zhang H, Zhong Z, Kong G, Khan J, Zou L, Jiang Y, Liu X, Tang Y, Jiang B, Peng C, Song Y, Liu S. Clinicopathological findings and imaging features of intraductal papillary neoplasms in bile ducts. PeerJ 2020; 8:e10040. [PMID: 33062441 PMCID: PMC7532777 DOI: 10.7717/peerj.10040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/04/2020] [Indexed: 12/16/2022] Open
Abstract
Background Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is considered an uncommon tumor, and there is limited understanding of IPMN-B. This study aimed to investigate the prognosis and influential factors of the IPMN-B from 58 cases. Methods The clinical data of 58 patients with pathologically confirmed IPMN-B admitted to our hospital from January 1, 2012 to August 2017 were collected and analyzed. The patients were followed up by outpatient or telephone until January 1, 2019. SPSS 19.0 software was applied for data analysis. Survival analysis was performed using Kaplan-Meier method and parallel Log-rank test. Prognostic factors were analyzed by univariate analysis and multiple Cox regression model. Results Among of all the patients, 26 cases were benign tumors and 32 cases were malignant tumors. The preoperative tumor markers CA242 and CEA of malignant IPNM-B patients were significantly higher than those in benign tumors (P < 0.05). Survival analysis showed that patients with malignant tumors had a worse prognosis. The median survival time of malignant IPMN-B patients was 40.6 ± 3.0 months, yet median survival time of benign IPMN-B patients was not reached (P = 0.19). The one-year survival rate and three-year survival rate of benign IPMN-B were 84% and 74% respectively. The one-year survival rate and three-year survival rate of malignant IPMN-B were 88% and 64% respectively. Univariate analysis showed that combined lymph node metastasis, surgical method, and differentiation degree could affect patients’ prognosis (P < 0.05). Multivariate analysis showed differentiation degree was an independent risk factor affecting prognosis (OR = 0.06, 95% confidence interval: 0.007∼0.486, P < 0.05). Conclusion The levels of CEA and CA242 were helpful to identify benign and malignant of IPNM-B. Moreover, radical surgical resection could prolong patients’ survival. Finally, differentiation degree was an independent risk factor affecting malignant IPNM-B prognosis.
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Affiliation(s)
- Honghui Zhang
- Department of Hepatobiliary Surgery/Hunan Research Center of Biliary Disease, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan province, China.,Biliary Disease Research Laboratory of Hunan Provincial People's Hospital, Key Laboratory of Hunan Normal University, Changsha, Hunan province, China.,Clinical Medical Technology Research Center of Hunan Provincial for Biliary Disease Prevention and Treatment, Changsha, Hunan province, China
| | - Zhendong Zhong
- Department of Hepatobiliary Surgery/Hunan Research Center of Biliary Disease, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan province, China.,Biliary Disease Research Laboratory of Hunan Provincial People's Hospital, Key Laboratory of Hunan Normal University, Changsha, Hunan province, China.,Department of Hepatobiliary Surgery, Changsha County People's Hospital/Hunan Provincial People's Hospital Xingsha Campus, Changsha, Hunan province, China
| | - Gaoyin Kong
- Department of Anesthesiology, Hunan Provincial People's Hospital/Clinical Research Center for Anesthesiology of ERAS in Hunan Province, Changsha, Hunan province, China
| | - Junaid Khan
- Department of Hepatobiliary Surgery/Hunan Research Center of Biliary Disease, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan province, China.,Biliary Disease Research Laboratory of Hunan Provincial People's Hospital, Key Laboratory of Hunan Normal University, Changsha, Hunan province, China.,Clinical Medical Technology Research Center of Hunan Provincial for Biliary Disease Prevention and Treatment, Changsha, Hunan province, China
| | - Lianhong Zou
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University/Hunan Provincial Institute of Emergency, Changsha, Hunan province, China
| | - Yu Jiang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University/Hunan Provincial Institute of Emergency, Changsha, Hunan province, China
| | - Xiehong Liu
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University/Hunan Provincial Institute of Emergency, Changsha, Hunan province, China
| | - Yixun Tang
- Department of Anesthesiology, Hunan Provincial People's Hospital/Clinical Research Center for Anesthesiology of ERAS in Hunan Province, Changsha, Hunan province, China
| | - Bo Jiang
- Department of Hepatobiliary Surgery/Hunan Research Center of Biliary Disease, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan province, China.,Biliary Disease Research Laboratory of Hunan Provincial People's Hospital, Key Laboratory of Hunan Normal University, Changsha, Hunan province, China.,Clinical Medical Technology Research Center of Hunan Provincial for Biliary Disease Prevention and Treatment, Changsha, Hunan province, China
| | - Chuang Peng
- Department of Hepatobiliary Surgery/Hunan Research Center of Biliary Disease, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan province, China.,Biliary Disease Research Laboratory of Hunan Provincial People's Hospital, Key Laboratory of Hunan Normal University, Changsha, Hunan province, China.,Clinical Medical Technology Research Center of Hunan Provincial for Biliary Disease Prevention and Treatment, Changsha, Hunan province, China
| | - Yinghui Song
- Department of Hepatobiliary Surgery/Hunan Research Center of Biliary Disease, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan province, China.,Biliary Disease Research Laboratory of Hunan Provincial People's Hospital, Key Laboratory of Hunan Normal University, Changsha, Hunan province, China.,Clinical Medical Technology Research Center of Hunan Provincial for Biliary Disease Prevention and Treatment, Changsha, Hunan province, China
| | - Sulai Liu
- Department of Hepatobiliary Surgery/Hunan Research Center of Biliary Disease, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan province, China.,Biliary Disease Research Laboratory of Hunan Provincial People's Hospital, Key Laboratory of Hunan Normal University, Changsha, Hunan province, China.,Clinical Medical Technology Research Center of Hunan Provincial for Biliary Disease Prevention and Treatment, Changsha, Hunan province, China
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Arai J, Kato J, Toda N, Kurokawa K, Shibata C, Kurosaki S, Funato K, Kondo M, Takagi K, Kojima K, Ohki M, Seki M, Tagawa K. Long-term survival after palliative argon plasma coagulation for intraductal papillary mucinous neoplasm of the bile duct. Clin J Gastroenterol 2020; 14:314-318. [PMID: 32779145 DOI: 10.1007/s12328-020-01199-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 07/25/2020] [Indexed: 12/15/2022]
Abstract
Intraductal papillary mucinous neoplasm of the bile duct (IPNB) is an epithelial tumor that can cause obstructive jaundice and cholangitis due to mucin production. Although the effectiveness of argon plasma coagulation in IPNB treatment has been demonstrated, the long-term effect of the therapy is largely unknown. Here, we have presented a patient with IPNB who underwent argon plasma coagulation with a follow-up period of more than 2 years. A 74-year-old woman was referred to our department for treatment of obstructive jaundice. Endoscopic retrograde cholangiopancreatography revealed marked dilation of intrahepatic and extrahepatic bile ducts and thick mucin drainage from the ampulla of Vater. IPNB was diagnosed pathologically from biopsy specimens. Surgery was not recommended because of the extensive intrahepatic spread of the lesion. Endoscopic sphincterotomy, endoscopic papillary large balloon dilation, and insertion of a metallic stent could not resolve the obstructive jaundice. Finally, argon plasma coagulation with percutaneous cholangioscopy was performed 3 times over 1 month. After treatment, obstructive jaundice was resolved and the patient's clinical condition has been stable for more than 2 years, except for a single episode of transient cholangitis. In conclusion, argon plasma coagulation may be an alternative to surgery for the palliation of jaundice with IPNB.
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Affiliation(s)
- Junya Arai
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Jun Kato
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Nobuo Toda
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
| | - Ken Kurokawa
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Chikako Shibata
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Shigeyuki Kurosaki
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kazuyoshi Funato
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Mayuko Kondo
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kaoru Takagi
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kentaro Kojima
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Masataka Ohki
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Michiharu Seki
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Kazumi Tagawa
- Department of Gastroenterology, Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan
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Uemura S, Higuchi R, Yazawa T, Izumo W, Matsunaga Y, Shiihara M, Ota T, Furukawa T, Yamamoto M. Prognostic Factors for Surgically Resected Intraductal Papillary Neoplasm of the Bile Duct: A Retrospective Cohort Study. Ann Surg Oncol 2020; 28:826-834. [PMID: 32651697 DOI: 10.1245/s10434-020-08835-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND To date, postoperative prognostic factors for intraductal papillary neoplasm of the bile duct (IPNB) have not been well-established. This study aimed to examine the histopathologic features and postoperative prognosis of the two IPNB subclassifications, as well as factors affecting prognosis, based on the authors' experience at a single institution. METHODS The study enrolled 83 patients who underwent surgical resection for pathologically diagnosed IPNB at the authors' institution. The clinicopathologic features and postoperative outcomes for these patients were examined. The study also investigated postoperative prognostic factors for IPNB using uni- and multivariate analyses. RESULTS More than half of the tumors (64%) diagnosed as IPNB were early-stage cancer (UICC Tis or T1). However, none were diagnosed as benign. The multivariate analysis showed that lymph node metastasis (hazard ratio [HR], 5.78; p = 0.002) and bile duct margin status with carcinoma in situ (D-CIS; HR, 5.10; p = 0.002) were independent prognostic factors, whereas MUC6 expression showed only a marginal influence on prediction of prognosis (HR, 0.32; p = 0.07). The tumor recurrence rate and the proportion of locoregional recurrence were significantly greater among the patients with D-CIS than among those with negative bile duct margins, including those patients with low-grade dysplasia. The patients with D-CIS showed a significantly poorer prognosis than those with negative bile duct margins (5-year survival, 38% versus 87%; p = 0.0002). CONCLUSIONS Evaluation of resected IPNBs showed cancer in all cases. Avoiding positive biliary stumps during surgery, including resection of carcinoma in situ, would improve the prognosis for patients with IPNB.
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Affiliation(s)
- Shuichiro Uemura
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Takehisa Yazawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Izumo
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yutaro Matsunaga
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masahiro Shiihara
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takehiro Ota
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Recurrence After Resection for Intraductal Papillary Neoplasm of Bile Duct (IPNB) According to Tumor Location. J Gastrointest Surg 2020; 24:804-812. [PMID: 31062272 DOI: 10.1007/s11605-019-04235-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND No studies have yet analyzed the characteristics of recurrence after resection for intraductal papillary neoplasm of bile duct (IPNB) based on tumor location. We analyzed the patterns, timing, and risk factors for recurrence. METHODS From 1994 to 2014, data from 103 patients who were diagnosed with IPNB were retrospectively reviewed. Among these, 44 were extrahepatic IPNB (E-IPNB) and 59 were intrahepatic IPNB (I-IPNB). RESULTS CK20, pancreaticobiliary type, tumor invasion beyond ductal wall, tumor invasion to adjacent organs, and invasive disease were more frequently found in E-IPNB than in I-IPNB (22.7 vs. 8.5%; p = 0.043, 38.6 vs. 23.7%; p = 0.050, 20.5 vs. 11.9%; p < 0.001, 4.5 vs. 1.7%; p < 0.001 and 93.2 vs. 55.9%; p < 0.001). E-IPNB has poorer 5-year recurrence-free survival (RFS) compared to I-IPNB (51.7 vs. 91.4%; p < 0.001). There was no significant difference in the rate of initial isolated locoregional recurrence and initial distant recurrence according to tumor location (14.6 in E-IPNB vs. 3.0% in I-IPNB; p = 0.123, 19.5 in E = IPNB vs. 12.0% in I-IPNB; p = 0.136). Recurrence rate according to timing was different between E-IPNB and I-IPNB: within 1 year (33.3% vs. 83.3%; p = 0.061) and 1-3 years (50.0% vs. 0%; p = 0.052). The independent prognostic factors for RFS were tumor location (p = 0.034) and lymph node metastasis (p = 0.013). CONCLUSIONS E-IPNB has a worse prognosis than I-IPNB. Different follow-up schedules for surveillance according to tumor location are needed after surgery.
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Nam NH, Taura K, Kanai M, Fukuyama K, Uza N, Maeda H, Yutaka Y, Chen-Yoshikawa TF, Muto M, Uemoto S. Unexpected metastasis of intraductal papillary neoplasm of the bile duct without an invasive component to the brain and lungs: A case report. World J Gastroenterol 2020; 26:366-374. [PMID: 31988595 PMCID: PMC6969881 DOI: 10.3748/wjg.v26.i3.366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/08/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite an expanding number of studies on intraductal papillary neoplasm of the bile duct (IPNB), distant metastasis remains unexplained especially in cases of carcinoma in situ. In the present study, we report a rare and interesting case of IPNB without invasive components that later metastasized to lungs and brain.
CASE SUMMARY A 69-year-old male was referred to our hospital due to suspected cholangiocarcinoma. Laboratory tests on admission reported a mild elevation of alkaline phosphatase, γ-glutamyl transpeptidase, and total bilirubin in serum. Endoscopic retrograde cholangiography revealed a filling defect in the common bile duct (CBD) extending to the left hepatic duct. Peroral cholangioscopy delineated a tumor in the CBD that had a papillary pattern. Multidetector computed tomography and magnetic resonance cholangiopancreatography detected partial blockage ot interlude in the CBD leading to cholestasis without evidence of metastasis. Therefore, a diagnosis of IPNB cT1N0M0 was established. Left hepatectomy with bile duct reconstruction was performed. Pathological examination confirmed an intraepithelial neoplasia pattern without an invasive component and an R0 resection achievement. The patient was monitored carefully by regular examinations. However, at 32 mo after the operation, a 26 mm tumor in the lungs and a 12 mm lesion in the brain were detected following a suspicious elevated CA 19-9 level. Video-assisted thoracoscopic surgery of left upper lobectomy and stereotactic radiotherapy are indicated. In addition to histopathological results, a genomic profiling analysis using whole exome sequencing subsequently confirmed lung metastasis originating from bile duct cancer.
CONCLUSION This case highlights the important role of genomic profiling analysis using whole exome sequencing in identifying the origin of metastasis in patients with IPNB.
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Affiliation(s)
- Nguyen Hai Nam
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Kojiro Taura
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Masashi Kanai
- Department of Clinical Oncology, Pharmacogenomics, and Palliative Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Keita Fukuyama
- Department of Clinical Oncology, Pharmacogenomics, and Palliative Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Norimitsu Uza
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hirona Maeda
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Yojiro Yutaka
- Department of Thoracic. Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Toyofumi F Chen-Yoshikawa
- Department of Thoracic. Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
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Shi J, Wan X, Xie Y, Lin J, Long J, Xu W, Liang Z, Sang X, Zhao H. CK20 and lymph node involvement predict adverse outcome of malignant intraductal papillary neoplasm of the bile duct. Histol Histopathol 2019; 35:449-456. [PMID: 31657857 DOI: 10.14670/hh-18-179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify prognostic factors of malignant intraductal papillary neoplasm of the bile duct (m-IPNB). MATERIALS AND METHODS We included 38 consecutive cases which underwent surgical resection and diagnosed as IPNB with malignant component from January 2003 to January 2017. Clinicopathological variables were collected to conduct survival analysis and identify prognostic factors. RESULTS The median overall survival (OS) of m-IPNB was 76.0 months, with 1-, 3-, and 5-year survival rates of 97.2%, 73.5%, and 59.8%, respectively. The median RFS was 48.0 months with 1-, 3-, and 5-year recurrence-free survival (RFS) rate was 83.2%, 59.8%, and 44.6%, respectively. Univariate analysis showed that elevation of carcinoembryonic antigen CEA, lymph node involvement, resection margin status, degree of periductal invasion, and positive expression of CK20 were associated with both OS and RFS of m-IPNB. After multivariate Cox models analysis, lymph node involvement and positive expression of CK20 were identified as independent prognostic factors for OS, while lymph node involvement and resection margin status were independent prognostic factors for RFS. The median OS of patients with m-IPNB involving lymphatic metastases and positive expression of CK20 was 27.0±8.8 months and 51.0±12.4 months, respectively. The median RFS of cases with lymph node involvement and R1 resection was 10.0±3.3 months and 25.0±6.9 months, respectively. However, there was no significant difference in OS or RFS between cases of pancreaticobiliary and intestinal subtype. CONCLUSIONS Lymph node involvement and positive expression of CK20 are independent prognostic factors for shorter OS of m-IPNB, while patients with lymph node involvement and positive resection margin are at higher risk of tumor recurrence.
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Affiliation(s)
- Jie Shi
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueshuai Wan
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Xie
- Department of Hepatobiliary Surgery II, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jianzhen Lin
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junyu Long
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiyu Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiyong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinting Sang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Haitao Zhao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Planned limited resection of the extrahepatic bile duct in a case of intraductal papillary neoplasm of the bile duct based on preoperative examinations. Clin J Gastroenterol 2019; 13:233-239. [PMID: 31598905 DOI: 10.1007/s12328-019-01049-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 09/24/2019] [Indexed: 12/23/2022]
Abstract
Intraductal papillary neoplasm of the bile duct (IPNB) is defined as a non-invasive malignancy; however, since there are disparities in its histological diagnosis, the operative strategy for typical IPNB has not yet been established. A 69-year-old male was diagnosed with a bile duct mass lesion at the confluence of the cystic duct by ultrasonography without clinical symptoms. Liver functional parameters and tumor markers were within normal ranges. Computed tomography showed an enhanced tumor with no findings of ductal invasion or node metastasis. The tumor was exposed in the hepatic duct lumen and biopsy via SpyGlass DS cholangiography revealed that it was a low-grade papillary lesion, indicating type 1 IPNB. Under preoperative diagnostic modalities, limited resection of the extrahepatic bile duct with D2 lymphadenectomy was planned and R0 resection was achieved. The postoperative histological diagnosis was type 1 IPNB without node metastasis. The postoperative course was uneventful and a good prognosis is expected at this stage. In the field of biliary surgery, although extended resection is generally performed for bile duct carcinomas, satisfactory limited surgical resection is possible for type 1 IPNB with lower malignant behavior.
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Zheng Q, Ruan SM, Shan QY, Xu M, Chen LD, Hu HT, Huang Y, Xie XY, Lu MD, Liao B, Wang W. Clinicopathological findings and imaging features of intraductal papillary neoplasm of the bile duct: comparison between contrast-enhanced ultrasound and contrast-enhanced computed tomography. Abdom Radiol (NY) 2019; 44:2409-2417. [PMID: 31093728 DOI: 10.1007/s00261-019-01987-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Intraductal papillary neoplasms of the bile duct (IPNBs) are a group of rare lesions with uncertain clinical findings and imaging features. We aim to investigate the clinicopathological features and imaging findings of IPNBs on contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT). METHODS From February 2005 to March 2018, 30 patients with pathologically confirmed IPNBs were retrospectively identified in our hospital. Demographic, clinical, and pathological data, CEUS and CECT features and surgical strategies were analyzed. RESULTS The most common clinical manifestations were abdominal pain (53.3%), jaundice (23.3%), and acute cholangitis (10.0%). Among all lesions, 5/30 (16.7%) lesions presented as dilated bile ducts only, while 13/30 (43.3%) lesions presented as dilated bile ducts with intraductal papillary masses, and 12/30 (40.0%) presented as solid masses with dilated bile ducts. For the 20 patients who underwent both CEUS and CECT, 18 lesions were hyperenhanced on CEUS, and 17 lesions were hyperenhanced on CECT in the arterial phase. In total, 16 and 18 lesions showed washout in the portal and late phases on CEUS, while the corresponding number of lesions that showed washout in the portal and late phases on CECT were 11 and 13. Twelve lesions (40.0%) showed atypical hyperplasia, while 16/30 (53.3%) lesions underwent malignant transformations. CONCLUSIONS There are 3 major forms of IPNBs on grayscale ultrasound, including diffusely dilated bile ducts without visible mass; focal dilated bile duct with intraductal papillary masses; and solid mass surrounded by dilated bile ducts. The enhancement patterns of IPNBs on CEUS and on CECT were consistent. IPNB has a high malignant potential, and patients should be treated with surgical resection after the diagnosis is established.
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Affiliation(s)
- Qiao Zheng
- Department of Medical Ultrasonics, Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Si-Min Ruan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Quan-Yuan Shan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Ming Xu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Li-Da Chen
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Yang Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Bing Liao
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China.
| | - Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.
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Matsumoto T, Kubota K, Hachiya H, Sakuraoka Y, Shiraki T, Shimizu T, Mori S, Iso Y, Kato M, Yamagishi H, Imai Y, Aoki T. Impact of Tumor Location on Postoperative Outcome of Intraductal Papillary Neoplasm of the Bile Duct. World J Surg 2019; 43:1313-1322. [PMID: 30659344 DOI: 10.1007/s00268-019-04913-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The concept of intraductal papillary neoplasm of the bile duct (IPNB) has been proposed to be the biliary equivalent of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. While the classification of IPMNs is based on their location of duct involvement, such classification has not been fully evaluated for IPNBs. The aim of this study is to investigate the value of IPNB classification based on its location. METHODS A total of 306 consecutive patients who underwent surgical resection with a diagnosis of bile duct tumor were enrolled. Among these patients, 21 were diagnosed as having IPNB. The IPNBs were classified into two groups as follows: extrahepatic IPNB, which located in the distal or perihilar bile duct, and intrahepatic IPNB, which located more peripherally than the hilar bile duct. The clinicopathological features of the two groups were then compared. RESULTS Extrahepatic IPNB tended to show more invasive characteristics than intrahepatic IPNB (presence of invasive component: 40.0 vs. 9.1%, p = 0.084). Moreover, patients with extrahepatic IPNB showed significantly poorer relapse-free survival (RFS) than those with intrahepatic IPNB [5-year RFS rate (%): 81.8 vs. 16.2, p = 0.014]. CONCLUSION Patients with intrahepatic IPNB show more favorable pathological characteristics and postoperative survival outcomes than those with extrahepatic IPNB.
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Affiliation(s)
- Takatsugu Matsumoto
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, 321-0293, Tochigi, Japan.
| | - Keiichi Kubota
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, 321-0293, Tochigi, Japan
| | - Hiroyuki Hachiya
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, 321-0293, Tochigi, Japan
| | - Yuhki Sakuraoka
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, 321-0293, Tochigi, Japan
| | - Takayuki Shiraki
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, 321-0293, Tochigi, Japan
| | - Takayuki Shimizu
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, 321-0293, Tochigi, Japan
| | - Shozo Mori
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, 321-0293, Tochigi, Japan
| | - Yukihiro Iso
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, 321-0293, Tochigi, Japan
| | - Masato Kato
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, 321-0293, Tochigi, Japan
| | - Hidetsugu Yamagishi
- Department of Diagnostic Pathology, Dokkyo Medical University Hospital, Mibu, 321-0293, Tochigi, Japan
| | - Yasuo Imai
- Department of Diagnostic Pathology, Dokkyo Medical University Hospital, Mibu, 321-0293, Tochigi, Japan
| | - Taku Aoki
- Department of Gastroenterological Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, 321-0293, Tochigi, Japan
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50
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Outcome Determining Factors of Intraductal Papillary Neoplasm of the Biliary Tract (IPNB)-a Single Center Survey and Analysis of Current Literature. J Gastrointest Cancer 2019; 50:160-169. [PMID: 30628030 DOI: 10.1007/s12029-018-00199-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Intraductal papillary neoplasms of the biliary tract (IPNB) are rare tumors originating from the bile duct epithelium. Metastatic disease of IPNB is extremely rare and only reported in a small number of cases worldwide. Due to this limitation in number, the treatment of IPNB mainly relies on retrospective case series. PATIENTS AND METHODS We reported three cases of IPNB, one benign, one carcinoma with lymph node metastasis, and one case with histologically proven metachronous pulmonary metastasis. We correlated our findings with the existing data found in the literature. All patients underwent hemihepatectomy and complete tumor resection was achieved. RESULTS Diagnosis of IPNB can be challenging due to varying presentation. The treatment of choice is surgical oncological resection in an early tumor stage. Long-term outcome highly depends on the underlying grade of dysplasia, multiplicity, and tumor-free margins. Aggressive tumor invasion is reported in up to 72% of cases in IPNB. Furthermore, the recurrence rate of IPNB is high with up to 22%. Further factors associated with an impaired survival are incomplete resection, lymph node involvement, and MUC1 expression. CONCLUSION High potential for dysplasia and proof of invasive carcinoma upon diagnosis are hallmarks of IPNB. Metastatic disease in IPNB is reported only in small numbers. IPNB is an aggressive tumor entity with impaired long-term outcomes. A drawback for interpretation of current data is the fact that they rely on case series and reports and are not validated through more powerful randomized multicentric trials.
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