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Intraductal tubulopapillary neoplasms of the bile ducts: identity, clinicopathologic characteristics, and differential diagnosis of a distinct entity among intraductal tumors. Hum Pathol 2023; 132:12-19. [PMID: 35934108 DOI: 10.1016/j.humpath.2022.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 02/07/2023]
Abstract
Among the mass-forming preinvasive (tumoral intraepithelial) neoplasms of the biliary tract, intraductal tubulopapillary neoplasms (ITPN-Bs) are increasingly being recognized as a separate category. By being intramucosal polypoid proliferations of dysplastic/neoplastic cells, they are highly similar to other members of the "intraductal neoplasms (IDNs)" category (namely, intraductal papillary neoplasms [IPNBs], and intraductal oncocytic papillary neoplasms [IOPNs]); however, they are distinguished by MUC6-expressing nonmucinous cells that lack intestinal differentiation and form striking tubular configuration. Their molecular/genetic profile is also proving to be different with frequent alterations in cell cycle and chromatin remodeling genes, which are quite uncommon in other IDNs and cholangiocarcinomas. Despite the conceptual overlaps, they are also very different from intracholecystic nonmucinous tubular neoplasms (ICTN) of the gallbladder with the latter being associated with Wnt/beta-catenin pathway alterations, and almost never invasive. In contrast, ITPN-Bs are invasive in an estimated 80% of the cases, although even invasive examples often exhibit a protracted course. Invasive carcinomas arising from ITPN-Bs are overall similar to cholangiocarcinomas (including small duct and large duct patterns) but also often have peculiar characteristics such as more nodular-compact (blunt invasion) pattern. Like other IDNs, the ITPN-Bs have also been classified in the past as intraductal-spreading type of cholangiocarcinomas (and they are still regarded as such in some publications). In small biopsies, they are prone to be mistaken as ordinary adenocarcinomas because of their tubular pattern and pancreatobiliary cytology although their relatively monotonous cytology and zones of back-to-back tubule formation can help in their correct identification. Clinical presentation of ITPN-Bs is generally similar to other intraductal neoplasms; however, in the intrahepatic component, they tend to be more nodular than cystic, and their snake-like intraductal growth pattern is often more striking. In the management (diagnosis and treatment) of these tumors that are in essence adenoma-carcinoma sequence, the invasive and noninvasive components ought to be evaluated separately. Minimally invasive examples are commonly curable, and even those more extensively invasive may have a surprisingly good prognosis. In summary, biliary ITPNs form a distinct category not only clinicopathologically, immunophenotypically, and molecular-wise but regarding their biological behavior as well.
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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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Balloon Extraction of an Intraductal Tubulopapillary Neoplasm of the Bile Duct During Endoscopic Retrograde Cholangiopancreatography. ACG Case Rep J 2020; 7:e00481. [PMID: 33269290 PMCID: PMC7685965 DOI: 10.14309/crj.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022] Open
Abstract
Intraductal tubulopapillary neoplasm (ITPN) of the bile duct is a rare type of intraductal neoplasm of the bile duct that has mainly been described in the literature in case reports and small case series. Only within the past decade has ITPN of the bile duct been identified as its own entity and have definitive diagnostic criteria been established. Given its rarity, there is no standard of care for treatment. Here, we describe a case report of biliary ITPN diagnosed in a unique manner.
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Kim JR, Jang KT, Jang JY, Lee K, Kim JH, Kim H, Kim SW, Kwon W, Choi DW, Heo J, Han IW, Hwang S, Kim WJ, Hong SM, Kim DS, Yu YD, Kim JY, Nah YW, Park HW, Choi HJ, Han HS, Yoon YS, Park SJ, Hong EK, Seo HI, Park DY, Kang KJ, Kang YN, Yu HC, Moon WS, Lim CS, Bae JM, Jo S, Lee W, Roh YH, Jeong JS, Jeong CY, Lee JS, Song IS, Kim KH, Kim HG, Cho CH, Joo SH, Won KY, Kim HJ, Choi JH, Chu CW, Lee JH, Park IY, Lee H, Lee SE, Kim HS, Lee HK, Cho MS, Kim H, Han KM. Clinicopathologic analysis of intraductal papillary neoplasm of bile duct: Korean multicenter cohort study. HPB (Oxford) 2020; 22:1139-1148. [PMID: 31837945 DOI: 10.1016/j.hpb.2019.11.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/02/2019] [Accepted: 11/11/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND IPNB is very rare disease and most previous studies on IPNB were case series with a small number due to low incidence. The aim of this study is to validate previously known clinicopathologic features of intraductal papillary neoplasm of bile duct (IPNB) based on the first largest multicenter cohort. METHODS Among 587 patients previously diagnosed with IPNB and similar diseases from each center in Korea, 387 were included in this study after central pathologic review. We also reviewed all preoperative image data. RESULTS Of 387 patients, 176 (45.5%) had invasive carcinoma and 21 (6.0%) lymph node metastasis. The 5-year overall survival was 80.9% for all patients, 88.8% for IPNB with mucosal dysplasia, and 70.5% for IPNB with invasive carcinoma. According to the "Jang & Kim's modified anatomical classification," 265 (68.5%) were intrahepatic, 103 (26.6%) extrahepatic, and 16 (4.1%) diffuse type. Multivariate analysis revealed that tumor invasiveness was a unique predictor for survival analysis. (p = 0.047 [hazard ratio = 2.116, 95% confidence interval 1.010-4.433]). CONCLUSIONS This is the first Korean multicenter study on IPNB through central pathologic and radiologic review process. Although IPNB showed good long-term prognosis, relatively aggressive features were also found in invasive carcinoma and extrahepatic/diffuse type.
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Affiliation(s)
- Jae Ri Kim
- Dept. of Surgery, Seoul National University College of Medicine (Seoul National University Hospital), South Korea
| | - Kee-Taek Jang
- Dept. of Pathology, Sungkyunkwan University School of Medicine (Samsung Medical Center), South Korea
| | - Jin-Young Jang
- Dept. of Surgery, Seoul National University College of Medicine (Seoul National University Hospital), South Korea.
| | - Kyungbun Lee
- Dept. of Pathology, Seoul National University College of Medicine (Seoul National University Hospital), South Korea
| | - Jung Hoon Kim
- Dept. of Radiology, Seoul National University College of Medicine (Seoul National University Hospital), South Korea
| | - Haeryoung Kim
- Dept. of Pathology, Seoul National University College of Medicine (Seoul National University Hospital), South Korea; Dept. of Pathology, Seoul National University College of Medicine (Seoul National University Bundang Hospital), South Korea
| | - Sun-Whe Kim
- Dept. of Surgery, Seoul National University College of Medicine (Seoul National University Hospital), South Korea
| | - Wooil Kwon
- Dept. of Surgery, Seoul National University College of Medicine (Seoul National University Hospital), South Korea
| | - Dong Wook Choi
- Dept. of Surgery, Sungkyunkwan University School of Medicine (Samsung Medical Center), South Korea
| | - JinSeok Heo
- Dept. of Surgery, Sungkyunkwan University School of Medicine (Samsung Medical Center), South Korea
| | - In Woong Han
- Dept. of Surgery, Sungkyunkwan University School of Medicine (Samsung Medical Center), South Korea
| | - Shin Hwang
- Dept. of Surgery, University of Ulsan College of Medicine (Asan Medical Center), South Korea
| | - Wan-Joon Kim
- Dept. of Surgery, University of Ulsan College of Medicine (Asan Medical Center), South Korea
| | - Seung-Mo Hong
- Dept. of Pathology, University of Ulsan College of Medicine (Asan Medical Center), South Korea
| | - Dong-Sik Kim
- Dept. of Surgery, Korea University College of Medicine, South Korea
| | - Young-Dong Yu
- Dept. of Surgery, Korea University College of Medicine, South Korea
| | - Joo Young Kim
- Dept. of Pathology, Korea University College of Medicine, South Korea
| | - Yang Won Nah
- Dept. of Surgery, University of Ulsan College of Medicine (Ulsan University Hospital), South Korea
| | - Hyung Woo Park
- Dept. of Surgery, University of Ulsan College of Medicine (Ulsan University Hospital), South Korea
| | - Hye-Jeong Choi
- Dept. of Pathology, University of Ulsan College of Medicine (Ulsan University Hospital), South Korea
| | - Ho-Seong Han
- Dept. of Surgery, Seoul National University College of Medicine (Seoul National University Bundang Hospital), South Korea
| | - Yoo-Seok Yoon
- Dept. of Surgery, Seoul National University College of Medicine (Seoul National University Bundang Hospital), South Korea
| | - Sang Jae Park
- Dept. of Surgery, National Cancer Center, South Korea
| | | | - Hyung Il Seo
- Dept. of Surgery, Pusan National University School of Medicine (Pusan National University Hospital), South Korea
| | - Do Youn Park
- Dept. of Pathology, Pusan National University School of Medicine (Pusan National University Hospital), South Korea
| | - Koo Jeong Kang
- Dept. of Surgery, Keimyung University School of Medicine, South Korea
| | - Yu Na Kang
- Dept. of Pathology, Keimyung University School of Medicine, South Korea
| | - Hee Chul Yu
- Dept. of Surgery, Chonbuk National University Medical School, South Korea
| | - Woo Sung Moon
- Dept. of Pathology, Chonbuk National University Medical School, South Korea
| | - Chang-Sup Lim
- Dept. of Surgery, Seoul National University College of Medicine (Boramae Medical Center), South Korea
| | - Jeong Mo Bae
- Dept. of Pathology, Seoul National University College of Medicine (Boramae Medical Center), South Korea
| | - Sungho Jo
- Dept. of Surgery, Dankook University College of Medicine, South Korea
| | - Wonae Lee
- Dept. of Pathology, Dankook University College of Medicine, South Korea
| | - Young Hun Roh
- Dept. of Surgery, Dong-A University College of Medicine, South Korea
| | - Jin Sook Jeong
- Dept. of Pathology, Dong-A University College of Medicine, South Korea
| | - Chi-Young Jeong
- Dept. of Surgery, Gyeongsang National University Postgraduate School of Medicine, South Korea
| | - Jong Sil Lee
- Dept. of Pathology, Gyeongsang National University Postgraduate School of Medicine, South Korea
| | - In-Sang Song
- Dept. of Surgery, Chungnam National University School of Medicine, South Korea
| | - Kyung-Hee Kim
- Dept. of Pathology, Chungnam National University School of Medicine, South Korea
| | - Ho Gak Kim
- Dept. of Surgery, Daegu Catholic University School of Medicine, South Korea
| | - Chang Ho Cho
- Dept. of Pathology, Daegu Catholic University School of Medicine, South Korea
| | - Sun-Hyung Joo
- Dept. of Surgery, Kyung Hee University School of Medicine, South Korea
| | - Kyu Yeoun Won
- Dept. of Pathology, Kyung Hee University School of Medicine, South Korea
| | - Hong Jin Kim
- Dept. of Surgery, Yeungnam University College of Medicine, South Korea
| | - Joon Hyuk Choi
- Dept. of Pathology, Yeungnam University College of Medicine, South Korea
| | - Chong-Woo Chu
- Dept. of Surgery, Pusan National University School of Medicine (Pusan National University Yangsan Hospital), South Korea
| | - Jung Hee Lee
- Dept. of Pathology, Pusan National University School of Medicine (Pusan National University Yangsan Hospital), South Korea
| | - Il Young Park
- Dept. of Surgery, Catholic University College of Medicine, South Korea
| | - Heejeong Lee
- Dept. of Pathology, Catholic University College of Medicine, South Korea
| | - Seung Eun Lee
- Dept. of Surgery, Chung-Ang University College of Medicine, South Korea
| | - Hee Sung Kim
- Dept. of Pathology, Chung-Ang University College of Medicine, South Korea
| | - Hyeon Kook Lee
- Dept. of Surgery, Ewha Womans University School of Medicine, South Korea
| | - Min-Sun Cho
- Dept. of Pathology, Ewha Womans University School of Medicine, South Korea
| | - Hongbeom Kim
- Dept. of Surgery, Seoul National University College of Medicine (Seoul National University Hospital), South Korea; Dept. of Surgery, Dongguk University College of Medicine (Dongguk University Ilsan Hospital), South Korea
| | - Kang Min Han
- Dept. of Pathology, Dongguk University College of Medicine (Dongguk University Ilsan Hospital), South Korea
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Geramizadeh B. Precursor Lesions of Cholangiocarcinoma: A Clinicopathologic Review. CLINICAL PATHOLOGY 2020; 13:2632010X20925045. [PMID: 32596664 PMCID: PMC7297471 DOI: 10.1177/2632010x20925045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/18/2020] [Indexed: 12/12/2022]
Abstract
Cholangiocarcinoma (CCA) develops through multistep carcinogenesis. During the past decades, 2 precursors have been proved to evolve to CCA. The 2 main precursor lesions of CCA are biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile duct. It is an interesting and relatively novel entity for the hepatobiliary surgeons, radiologists, oncologists, and pathologists. It worth being familiar with these 2 entities for better communication between pathologists, oncologists, and surgeons to improve the treatment and follow-up of these lesions, which can definitely decrease their evolvement to CCA as an aggressive, poor prognostic, and life-threatening cancer. In this narrative review, I collected and discussed all published studies about these 2 precursor lesions of CCA including radiologic, clinical, and pathological manifestation.
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran.,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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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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Targeted next-generation sequencing identifies distinct clinicopathologic and molecular entities of intraductal papillary neoplasms of the bile duct. Mod Pathol 2019; 32:1637-1645. [PMID: 31231124 DOI: 10.1038/s41379-019-0306-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/13/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022]
Abstract
Intraductal papillary neoplasm of the bile duct (IPNB) is a mass-forming neoplasm in the bile duct considered to be the biliary counterpart of pancreatic intraductal papillary mucinous neoplasm (IPMN). By its cell lineage, IPNB can be classified into gastric, intestinal, pancreatobiliary, and oncocytic types. Recently, a group of Japanese and Korean pathologists proposed that IPNB be classified into two types, with type 1, being the histological counterpart of IPMN and type 2, having a more complex histological architecture. We used targeted next-generation sequencing to study the molecular change of 37 IPNBs and identified frequent mutations of KRAS (49%), GNAS (32%), RNF43 (24%), APC (24%), TP53 (24%), and CTNNB1 (11%) in IPNBs. Intestinal-type IPNB was associated with KRAS, GNAS, and RNF43 mutations. Japan-Korea consensus type 1 was associated with KRAS and GNAS mutations. All four IPNBs with CTNNB1 mutations were of pancreatobiliary type and located in the extrahepatic bile duct. A hierarchical analysis identified three distinct groups within IPNB: group 1 was Japan-Korea consensus type 1 tumors with macroscopic mucin, old age, and frequent KRAS, GNAS, and RNF43 mutations. Group 2 was Japan-Korea consensus type 2 with intestinal differentiation and frequent KRAS mutation but rare GNAS mutation, MUC2 expression, and macroscopic mucin. Group 3 was characterized by CTNNB1 mutation, extrahepatic location, lack of expression of intestinal markers, Japan-Korea consensus type 2, and lack of mutations in KRAS, APC, RNF43, and GNAS. Our results indicated that IPNB is a heterogeneous disease and that the activation of Ras-mitogen-activated protein kinase (MAPK), Wnt/β-catenin, and G-protein-coupled receptor (GPCR)-cAMP signaling is the main oncogenic mechanism of IPNB.
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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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Hasebe T, Sawada K, Hayashi H, Nakajima S, Takahashi H, Hagiwara M, Imai K, Yuzawa S, Fujiya M, Furukawa H, Okumura T. Long-term growth of intrahepatic papillary neoplasms: A case report. World J Gastroenterol 2019; 25:5569-5577. [PMID: 31576101 PMCID: PMC6767986 DOI: 10.3748/wjg.v25.i36.5569] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/29/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile duct (IPNB) is a type of tumor that presents in the intra- or extrahepatic bile ducts. Cystic-type intrahepatic IPNB often mimics simple liver cysts, making the diagnosis difficult. Because the growth of IPNB is slow, careful follow-up and timely therapeutic intervention is recommended. There are few reports with a follow-up period longer than a decade; thus, we report the case of a patient with an IPNB that grew for over 13 years.
CASE SUMMARY A 65-year-old man was diagnosed, 13 years prior with a cystic hepatic tumor with abnormal imaging findings. The targeted tumor biopsy results showed no malignancy. Biannual follow-up examinations were performed because of the potential for malignancy. The cystic lesions showed gradual enlargement over 11 years and a 4 mm papillary proliferation appeared on the cyst wall, which is compatible with IPNB. The tumor was observed for another 2 years because of the patient’s wishes. The imaging findings showed enlargement to 8 mm and a new 9 mm papillary proliferation of the cystic tumor. Contrast-enhanced ultrasonography showed hyperenhancement during the arterial phase in both cyst walls, indicating intraductal tumor progression in both tumors. Thus, liver segment 8 subsegmentectomy was performed. The pathological findings indicated that the tumors contained mucin, and high-grade atypia was observed in the papillary lesions, showing IPNB.
CONCLUSION The development of IPNB should be monitored in patients with cystic lesions and ultrasonography are useful tool for the evaluation.
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Affiliation(s)
- Takumu Hasebe
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Koji Sawada
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Hidemi Hayashi
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Shunsuke Nakajima
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Hiroyuki Takahashi
- Department of Surgery, Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Masahiro Hagiwara
- Department of Surgery, Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Koji Imai
- Department of Surgery, Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Sayaka Yuzawa
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa 0788510, Hokkaido, Japan
| | - Mikihiro Fujiya
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Hiroyuki Furukawa
- Department of Surgery, Division of Gastroenterological and General Surgery, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
| | - Toshikatsu Okumura
- Department of Medicine, Division of Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
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Harada F, Matsuyama R, Mori R, Kumamoto T, Morioka D, Taguri M, Yamanaka S, Endo I. Outcomes of surgery for 2010 WHO classification-based intraductal papillary neoplasm of the bile duct: Case–control study of a single Japanese institution's experience with special attention to mucin expression patterns. Eur J Surg Oncol 2019; 45:761-768. [DOI: 10.1016/j.ejso.2018.10.532] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/20/2018] [Accepted: 10/22/2018] [Indexed: 01/18/2023] Open
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Baterdene N, Hwang S, Lee JW, Jung MJ, Shin H, Seo HK, Kim MH, Lee SK. Surgical treatment of mucin-producing cholangiocarcinoma arising from intraductal papillary neoplasm of the intrahepatic bile duct: a report of 2 cases. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2016; 20:137-43. [PMID: 27621752 PMCID: PMC5018950 DOI: 10.14701/kjhbps.2016.20.3.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 06/19/2016] [Accepted: 06/22/2016] [Indexed: 12/28/2022]
Abstract
Intraductal papillary neoplasms of the bile duct (IPNB) leads to malignant transformation and mucin production. Herein, we presented two cases of mucin-producing IPNB with obstructive jaundice who underwent resection of the intrahepatic lesions and bypass hepaticojejunostomy. The first case was a 69 year-old male patient with 5-year follow up for gallstone disease. Imaging studies showed mucin-secreting IPNB mainly in the hepatic segment III bile duct (B3) and multiple intrahepatic duct stones for which, segment III resection, intrahepatic stone removal, end-to-side choledochojejunostomy and B3 hepaticojejunostomy were conducted. The second case was a 74 year-old female patient with 11-year follow up for gallstone disease. Imaging studies showed mucin-producing IPNB with dilatation of the segment IV duct (B4) and mural nodules for which, segment IV resection, partial resection of the diaphragm and central hepaticojejunostomy were conducted. Both patients recovered uneventfully from surgery. These cases highlight that in patients with IPNB, abundant production of highly viscous mucin inducing obstructive jaundice may be associated with malignant transformation.
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Affiliation(s)
- Namsrai Baterdene
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.; Department of General Surgery, Mongolian National University of Medical Science Hospital, Ulaanbaatar, Mongolia
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Wook Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Jae Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heeji Shin
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Kyoung Seo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myeong-Hwan Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Koo Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim WJ, Hwang S, Lee YJ, Kim KH, Park KM, Ahn CS, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Kim MH, Lee SK, Seo DW, Park DH, Lee SS, Lee SG. Clinicopathological Features and Long-Term Outcomes of Intraductal Papillary Neoplasms of the Intrahepatic Bile Duct. J Gastrointest Surg 2016; 20:1368-75. [PMID: 26873016 DOI: 10.1007/s11605-016-3103-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/02/2016] [Indexed: 01/31/2023]
Abstract
We intended to investigate the clinicopathological features of intrahepatic intraductal papillary neoplasms of the bile duct (IPNB), especially their malignant features and post-resection prognosis. Forty-three patients who met the definition of IPNB and who underwent liver resection between January 2002 and June 2015 were selected from our institutional database of liver resection cases. The mean age was 63.3 ± 6.9 years and 24 were male. Hepatolithiasis was present in addition in 10 of the patients. Left- and right-sided hepatectomies and concurrent bile duct resection (BDR) were performed in 28, 15, and 10 patients, respectively; R0 resection was performed in 37 patients. The mean tumor diameter was 4.1 ± 2.2 cm. Histological tumor grade was low in 4 cases, intermediate in 6, and malignant in 33. There was no cancer-related recurrence or death in the 10 patients with low-grade or intermediate lesions. In the 33 patients with malignant lesions, rates of tumor recurrence and overall survival were 12.5 and 96.2 % at 1 year, 36.4 and 91.3 % at 3 years, and 47.0 and 68.8 % at 5 years, respectively. Multivariate analysis showed that R1 resection was the only prognostic factor for tumor recurrence and patient survival. BDR was performed in only 2 of 6 patients undergoing R1 resection. Intrahepatic IPNB is a rare type of biliary neoplasm that encompasses a histological spectrum ranging from benign disease to invasive malignancy. Long-term survival was anticipated after curative resection. R1 resection reduced survival outcomes; therefore, we suggest that concurrent BDR should be performed if the resection margin of the bile duct is not reliably free of neoplastic involvement.
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Affiliation(s)
- Wan-Joon Kim
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea.
| | - Yong-Joo Lee
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Ki-Hun Kim
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Kwang-Min Park
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Chul-Soo Ahn
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Deok-Bog Moon
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Tae-Yong Ha
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Gil-Chun Park
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
| | - Myeong-Hwan Kim
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Ulsan, Seoul, South Korea
| | - Sung-Koo Lee
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Ulsan, Seoul, South Korea
| | - Dong Wan Seo
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Ulsan, Seoul, South Korea
| | - Do Hyun Park
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Ulsan, Seoul, South Korea
| | - Sang Soo Lee
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Ulsan, Seoul, South Korea
| | - Sung-Gyu Lee
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
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13
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Tan Y, Milikowski C, Toribio Y, Singer A, Rojas CP, Garcia-Buitrago MT. Intraductal papillary neoplasm of the bile ducts: A case report and literature review. World J Gastroenterol 2015; 21:12498-12504. [PMID: 26604656 PMCID: PMC4649132 DOI: 10.3748/wjg.v21.i43.12498] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/20/2015] [Accepted: 08/25/2015] [Indexed: 02/06/2023] Open
Abstract
Intraductal papillary neoplasm of the bile duct (IPNB) is a rare bile duct neoplasm mostly found in far eastern nations where hepatolithiasis and clonorchiasis infections are endemic. In western countries, it is very rare and the etiology is unknown. In this article, we report the first IPNB patient we encountered in our clinic and a literature review. The patient is a 38-year-old female with a history of choledocholithiasis who presented with obstructive jaundice. She was found to have a papillary mass at the junction of the right hepatic duct and common hepatic duct with six masses in the liver parenchyma. The immunophenotypic and histologic features of the tumor are consistent with IPNB, gastric subtype. The patient had a partial hepatectomy and has been receiving palliative chemotherapy. In a search of PubMed database, we collected 354 IPNB patients reported in 22 articles. In these patients, 52.8% were from Japan and 27.7% were from western countries including the United States (11.0%). The age of the patients ranged from 35 to 80 years old with an average of 64.6. Male/female ratio was 1.5. Macroscopically, 57.5% of the tumors were in the left lobe and 29.5% were in the right lobe. The average size of the tumor were 4.2 cm at the time of diagnosis. Histologically, pancreato-biliary subtype accounted for 41.8%, intestinal 28.0%, gastric 13.5% and oncocytic 16%. An invasive component is most often present in the pancreato-biliary and gastric subtypes. Despite recent advanced technologies, diagnosis of IPNB is still challenging, especially in western countries due to its rarity. Defined clinico-pathologic features are in demand for the accurate diagnosis and proper treatment.
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MESH Headings
- Adenocarcinoma, Papillary/chemistry
- Adenocarcinoma, Papillary/pathology
- Adenocarcinoma, Papillary/therapy
- Adult
- Bile Duct Neoplasms/chemistry
- Bile Duct Neoplasms/pathology
- Bile Duct Neoplasms/therapy
- Biomarkers, Tumor/analysis
- Biopsy
- Chemotherapy, Adjuvant
- Female
- Hepatectomy
- Hepatic Duct, Common/chemistry
- Hepatic Duct, Common/pathology
- Hepatic Duct, Common/surgery
- Humans
- Immunohistochemistry
- Magnetic Resonance Imaging
- Neoplasm Invasiveness
- Neoplasms, Multiple Primary/chemistry
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Palliative Care
- Tomography, X-Ray Computed
- Treatment Outcome
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14
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Metástasis biliares intraductales de carcinoma colorrectal: a propósito de 2 casos. RADIOLOGIA 2014; 56:e34-7. [DOI: 10.1016/j.rx.2013.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 01/05/2013] [Accepted: 01/11/2013] [Indexed: 02/02/2023]
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15
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Le Bail B. [Pathology of gallbladder and extrahepatic bile ducts. Case 8. Intraductal papillary neoplasm of extrahepatic bile duct without invasive carcinoma (WHO 2010), with high-grade intraepithelial neoplasia/carcinoma in situ (pTisNx, TNM 7th edition): "Dysplastic degenerated biliary papillomatosis, but non-invasive"]. Ann Pathol 2014; 34:324-33. [PMID: 25132444 DOI: 10.1016/j.annpat.2014.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 06/13/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Brigitte Le Bail
- Service de pathologie, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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16
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Kishida N, Shinoda M, Masugi Y, Itano O, Fujii-Nishimura Y, Ueno A, Kitago M, Hibi T, Abe Y, Yagi H, Tanimoto A, Tanabe M, Sakamaoto M, Kitagawa Y. Cystic tumor of the liver without ovarian-like stroma or bile duct communication: two case reports and a review of the literature. World J Surg Oncol 2014; 12:229. [PMID: 25047921 PMCID: PMC4119182 DOI: 10.1186/1477-7819-12-229] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 07/04/2014] [Indexed: 02/07/2023] Open
Abstract
We report two cases of cystic neoplasm of the liver with mucinous epithelium in which both ovarian-like stroma and bile duct communication were absent. The first case was a 41-year-old woman. She underwent right trisegmentectomy due to a multilocular cystic lesion, 15 cm in diameter, with papillary nodular components in the medial segment and right lobe. Histologically, arborizing papillae were seen in the papillary lesion. The constituent neoplastic cells had sufficient cytoarchitectural atypia to be classified as high-grade dysplasia. The second case was a 60-year-old woman. She underwent left lobectomy due to a unilocular cystic lesion, 17 cm in diameter, in the left lobe. Histologically, the cyst wall was lined by low columnar epithelia with slight cellular atypia. In both cases, neither ovarian-like stroma nor bile duct communications were found throughout the resected specimen. According to the most recent World Health Organization (WHO) classification in 2010, cystic tumors of the liver with mucinous epithelium are classified as mucinous cystic neoplasms when ovarian-like stromata are found, and as intraductal papillary neoplasm of bile duct when bile duct communication exists. Therefore, we diagnosed the cystic tumors as ‘biliary cystadenoma’ according to the past WHO classification scheme from 2000. We believe that the combined absence of both ovarian-like stroma and bile duct communication is possible in mucinous cystic tumors of the liver. Herein, we have described the clinicopathologic features of the two cases and reviewed past cases in the literature.
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Affiliation(s)
| | - Masahiro Shinoda
- Department of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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17
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Machado MA, Makdissi FF, Surjan RC. Totally Laparoscopic Right Hepatectomy with Roux-en-Y Hepaticojejunostomy for Right-Sided Intraductal Papillary Mucinous Neoplasm of the Bile Duct. Ann Surg Oncol 2014; 21:1841-1843. [DOI: 10.1245/s10434-014-3517-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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18
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Nakanuma Y, Sato Y, Ojima H, Kanai Y, Aishima S, Yamamoto M, Ariizumi SI, Furukawa T, Hayashi H, Unno M, Ohta T. Clinicopathological characterization of so-called "cholangiocarcinoma with intraductal papillary growth" with respect to "intraductal papillary neoplasm of bile duct (IPNB)". INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:3112-3122. [PMID: 25031730 PMCID: PMC4097227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 05/26/2014] [Indexed: 06/03/2023]
Abstract
Cholangiocarcinoma (CC) of the biliary tract occasionally presents a predominant intraductal papillary growth in the bile ducts, called as biliary tract carcinoma (BTC) of papillary growth (PG) and intrahepatic CC (ICC) of intraductal growth (IG) type. Recently, intraductal papillary neoplasm of bile duct (IPNB) has been proposed as a pre-invasive biliary neoplasm. This study was performed to characterize pathologically BTC of PG type and ICC of IG type with respect to IPNB. It was found that 126 of such 154 CCs (81.8%) fulfilled the criteria of IPNB, while the remaining 28 cases showed different histologies, such as tubular adenocarcinoma and carcinosarcoma. These IPNBs occurred in old aged patients with a male predominance, and the left lobe was rather frequently affected in the liver. A majority of these cases were high grade IPNB (43 cases) and invasive IPNB (77 cases), while low grade IPNB was rare (6 cases). Pancreatobiliary type was predominant (48 cases) followed by gastric (30 cases), intestinal (29 cases) and oncocytic (19 cases) types. Mucus hypersecretion was found in 45 cases, and this was frequent in IPNB at the intrahepatic large bile duct and hilar bile ducts but rare at the extrahepatic bile ducts. Interestingly, 36 cases of high grade and invasive IPNBs contained foci of moderately differentiated adenocacinoma within the intraductal papillary tumor. In conclusion, a majority of ICC of IG type and BTC of PG type could be regarded as a IPNB lineage, and clinically detectable IPNBs were already a malignant papillary lesion.
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Affiliation(s)
- Yasuni Nakanuma
- Department of Human Pathology, Kanazawa University Graduate School of MedicineKanazawa
- Department of Pathology, Shizuoka Cancer CenterShizuoka
| | - Yasunori Sato
- Department of Human Pathology, Kanazawa University Graduate School of MedicineKanazawa
| | | | - Yae Kanai
- Department of Pathology, National Cancer CenterTokyo
| | - Shinichi Aishima
- Department of Pathology, Kyushu University Graduate School of MedicineFukuoka
| | - Masakazu Yamamoto
- Department of Gastrointestinal Surgery, Tokyo Women’s College of MedicineTokyo
| | - Shun-ichi Ariizumi
- Department of Gastrointestinal Surgery, Tokyo Women’s College of MedicineTokyo
| | - Toru Furukawa
- Department of Pathology, Tokyo Women’s College of MedicineTokyo
| | - Hiroki Hayashi
- Department of Hepatobiliary Pancreatic Surgery, Tohoku University Graduate School of MedicineSendai
| | - Michiaki Unno
- Department of Hepatobiliary Pancreatic Surgery, Tohoku University Graduate School of MedicineSendai
| | - Tetsuo Ohta
- Department of Hepatobiliary Pancreatic Surgery, Kanazawa University Graduate of MedicineKagoshima, Japan
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19
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Pyloric gland type intraductal tubular adenoma of the liver. Pathology 2013; 45:710-3. [PMID: 24247635 DOI: 10.1097/pat.0000000000000020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Intraduktale papilläre Neoplasien der Gallenwege (IPNB). DER PATHOLOGE 2013; 34 Suppl 2:235-40. [DOI: 10.1007/s00292-013-1861-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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Sato H, Sato Y, Harada K, Sasaki M, Hirano K, Nakanuma Y. Metachronous intracystic and intraductal papillary neoplasms of the biliary tree. World J Gastroenterol 2013; 19:6125-6126. [PMID: 24106418 PMCID: PMC3785639 DOI: 10.3748/wjg.v19.i36.6125] [Citation(s) in RCA: 6] [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: 01/09/2013] [Revised: 03/27/2013] [Accepted: 05/18/2013] [Indexed: 02/06/2023] Open
Abstract
A 77-year-old woman complained of epigastralgia, and a tumor (5 cm in diameter) of the gallbladder neck was detected by image analysis. Following cholecystectomy, the tumor was pathologically diagnosed as intraductal papillary neoplasm (IPN), gastric type, with associated invasive carcinoma. About 10 mo later, intraluminal multiple masses (3 foci, up to 1.8 cm) were noted in the extrahepatic bile duct, and the resected specimen showed that all tumors had similar gross and microscopic features as seen in gallbladder IPN without invasion, and they were synchronous multiple lesions. This case showed a papillary tumor of the gallbladder of gastric phenotype, and confirmed that the gallbladder is a target of IPN in addition to the bile ducts.
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MESH Headings
- Adenocarcinoma, Papillary/chemistry
- Adenocarcinoma, Papillary/pathology
- Adenocarcinoma, Papillary/surgery
- Aged
- Bile Duct Neoplasms/chemistry
- Bile Duct Neoplasms/pathology
- Bile Duct Neoplasms/surgery
- Bile Ducts, Extrahepatic/chemistry
- Bile Ducts, Extrahepatic/pathology
- Bile Ducts, Extrahepatic/surgery
- Biomarkers, Tumor/analysis
- Biopsy
- Cholangiopancreatography, Endoscopic Retrograde
- Cholecystectomy
- Female
- Gallbladder Neoplasms/chemistry
- Gallbladder Neoplasms/pathology
- Gallbladder Neoplasms/surgery
- Humans
- Neoplasm Invasiveness
- Neoplasms, Second Primary/chemistry
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/surgery
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22
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Precancerous lesions of the biliary tree. Best Pract Res Clin Gastroenterol 2013; 27:285-97. [PMID: 23809246 DOI: 10.1016/j.bpg.2013.04.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 04/14/2013] [Indexed: 01/31/2023]
Abstract
The neoplasms of the biliary tree include the carcinomas of the intra- and extrahepatic bile ducts, the gallbladder and the ampulla. Two types of precancerous lesions precede these adenocarcinomas: the flat and non-tumour forming type that is called biliary intraepithelial neoplasia, and the papillary and tumour-forming type that has been named intraductal papillary neoplasm of the bile duct. Rarely also biliary mucinous cystic neoplasm can give rise to invasive biliary adenocarcinomas. This review discusses the pathological, molecular, epidemiological, clinical and prognostic features of the precancerous biliary lesions, separated according to their origin in the bile ducts, the ampulla and the gall bladder.
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23
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Jang GW, Hwang S, Lee YJ, Kim KH, Park KM, Ahn CS, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Lee SG. Clinicopathological features of the intraductal papillary neoplasms of the intrahepatic bile duct. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:138-41. [PMID: 26388924 PMCID: PMC4574998 DOI: 10.14701/kjhbps.2012.16.4.138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 10/20/2012] [Accepted: 10/22/2012] [Indexed: 12/28/2022]
Abstract
Backgrounds/Aims This study is intended to investigate the clinicopathological features of the intraductal papillary neoplasms of the intrahepatic bile duct (IPNB), especially focused on malignant changes. Methods From the institutional database of liver resection cases (Asan Medical Center, University of Ulsan College of Medicine), 18 patients who met the definition of IPNB were selected. They had undergone liver resection between February 2002 and October 2006; thus, the follow-up period was more than 5 years. Results Of the 18 patients, 11 patients were male. Their mean age was 61.3±6.7 years. There were no differences between the non-malignant and malignant lesions, in the comparison of the CEA levels (5.6±2.7 vs.12.6±31.1 ng/ml, p=0.439) and the CA19-9 levels (29.2±34.7 vs.31.9±30.2 ng/ml, p=0.871). The common radiologic findings were: intraductal growing mass in 10; bile duct dilatation in 6; and saccular duct dilatation in 2. Left and right hepatectomies were performed in 15 and 3, respectively. Five patients showed benign lesions of IPNB, and 13 patients revealed malignant lesions of intraductal papillary adnocarcinoma or cholangiocarcinoma. All 4 patients with benign lesions survived for a mean period of 53 months without recurrence. In 13 patients with the malignant lesions, 1-year, 3-year, and 5-year survival rates were 100%, 84.6%, and 59.2%, respectively. Conclusions We concluded that intrahepatic IPNB is a rare type of biliary neoplasm which includes a histological spectrum, ranging from benign disease to invasive malignancy. The long-term survival was anticipated after complete curative resection.
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Affiliation(s)
- Gi-Woong Jang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Joo Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang-Min Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok-Bog Moon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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