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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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Xiao G, Xia T, Mou YP, Zhou YC. Reoperation for heterochronic intraductal papillary mucinous neoplasm of the pancreas after bile duct neoplasm resection: A case report. World J Gastrointest Surg 2023; 15:1542-1548. [PMID: 37555129 PMCID: PMC10405119 DOI: 10.4240/wjgs.v15.i7.1542] [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: 03/24/2023] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile duct (IPNB) and intraductal papillary mucinous neoplasm (IPMN) of the pancreas have similar pathological manifestations. However, they often develop separately and it is rare for both to occur together. Patients presenting with heterochronic IPMN after IPNB are prone to be misdiagnosed with tumor recurrence. CASE SUMMARY A 67-year-old male patient was admitted 8.5 years after IPNB carcinoma and 4 years after the discovery of a pancreatic tumor. A left hepatic bile duct tumor with distal bile duct dilatation was found 8.5 years ago by the computed tomography; therefore, a left hepatectomy was performed. The postoperative pathological diagnosis was malignant IPNB with negative cutting edge and pathological stage T1N0M0. Magnetic resonance imaging 4 years ago showed cystic lesions in the pancreatic head with pancreatic duct dilatation, and carcinoembryonic antigen continued to increase. Positron emission tomography showed a maximum standard uptake value of 11.8 in the soft tissue mass in the pancreatic head, and a malignant tumor was considered. Radical pancreatoduodenectomy was performed. Postoperative pathological diagnosis was pancreatic head IPMN with negative cutting edge, pancreaticobiliary type, stage T3N0M0. He was discharged 15 d after the operation. Follow-up for 6 mo showed no tumor recurrence, and quality of life was good. CONCLUSION IPNB and IPMN are precancerous lesions with similar pathological characteristics and require active surgery and long-term follow-up.
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Affiliation(s)
- Gang Xiao
- Department of Hepatopancreatobiliary Surgery, Shaoxing People’s Hospital, Shaoxing 312000, Zhejiang Province, China
| | - Tao Xia
- Division of Gastrointestinal and Pancreatic Surgery, Department of General Surgery, Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College), Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou 310014, Zhejiang Province, China
| | - Yi-Ping Mou
- Division of Gastrointestinal and Pancreatic Surgery, Department of General Surgery, Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College), Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou 310014, Zhejiang Province, China
| | - Yu-Cheng Zhou
- Division of Gastrointestinal and Pancreatic Surgery, Department of General Surgery, Zhejiang Provincial People’s Hospital (People’s Hospital of Hangzhou Medical College), Key Laboratory of Gastroenterology of Zhejiang Province, Hangzhou 310014, Zhejiang Province, China
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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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Bansal A, Thung SN, Zhu H, Schwartz M, Lewis S. Synchronous pancreatic adenocarcinoma and intrahepatic cholangiocarcinoma arising in the context of intraductal papillary neoplasms. Clin Imaging 2016; 40:897-901. [PMID: 27183137 DOI: 10.1016/j.clinimag.2015.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/04/2015] [Indexed: 02/07/2023]
Abstract
Field cancerization theory provides rationale for the development of multiple pancreatic ductal and biliary lesions in a single patient through the development and accumulation of multiple genetic changes. Genetic alterations result in the development of precursor lesions including intraductal papillary mucinous neoplasms of the pancreas (IPMN), intraductal papillary neoplasm of the bile duct (IPN-B), and their malignant counterparts, pancreatic adenocarcinoma and cholangiocarcinoma. Although IPMN are frequently encountered, IPN-B are uncommon and the synchronous occurrence of both lesions is rare. We present a case of synchronous pancreatic adenocarcinoma and intrahepatic cholangiocarcinoma with histopathologic evidence of underlying precursor lesions, IPMN-P and IPN-B.
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Affiliation(s)
- Anmol Bansal
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029
| | - Swan N Thung
- The Lillian and Henry Stratton-Hans Popper Department of Pathology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029
| | - Hongfa Zhu
- The Lillian and Henry Stratton-Hans Popper Department of Pathology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029
| | - Myron Schwartz
- Department of Surgery, RMTI Liver Surgery Program, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029.
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Xu XW, Li RH, Zhou W, Wang J, Zhang RC, Chen K, Mou YP. Laparoscopic resection of synchronous intraductal papillary mucinous neoplasms: A case report. World J Gastroenterol 2012; 18:6510-6514. [PMID: 23197900 PMCID: PMC3508649 DOI: 10.3748/wjg.v18.i44.6510] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 09/28/2012] [Indexed: 02/06/2023] Open
Abstract
We describe herein a 68-year-old woman who was diagnosed with a quite rare entity of intraductal papillary mucinous neoplasms (IPMNs) occurring simultaneously in the left lateral lobe of liver and the tail of pancreas. Abdominal computed tomography and magnetic resonance cholangiopancreatography showed a cystic dilatation of the pancreatic duct in the pancreatic tail, which suggested an IPMN, and multiple intrahepatic duct stones in the left lateral lobe. The patient underwent a laparoscopic left lateral hepatolobectomy and spleen-preserving distal pancreatectomy. Intra-operative finding of massive mucin in the dilated bile duct implied an intraductal mucinous tumor in the liver. The diagnosis of synchronous IPMNs in the liver and pancreas was confirmed by pathological examination. The patient was followed up for 6 mo without signs of recurrence. Although several cases of IPMN of liver without any pancreatic association have been reported, the simultaneous occurrence of IPMNs in the liver and pancreas is very rare. To the best of our knowledge, it is the first reported case treated by laparoscopic resection.
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MESH Headings
- Aged
- Biopsy
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/surgery
- Cholangiopancreatography, Magnetic Resonance
- Female
- Hepatectomy/methods
- Humans
- Laparoscopy
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Pancreatectomy/methods
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/surgery
- Tomography, X-Ray Computed
- Treatment Outcome
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