Fine-needle aspiration cytologic diagnosis of intrahepatic biliary papillomatosis (intraductal papillary tumor): Report of three cases and comparative study with cholangiocarcinoma

Abstract

Biliary papillomatosis is a rare tumor of the intrahepatic and extrahepatic biliary tree, and its FNA findings have not been reported. The cytologic features of 3 cases of intrahepatic biliary papillomatosis were studied and compared with 5 cases of chol-Key Words: biliary papillomatosis; intraductal papillary tumor; cholangiocarcinoma; biliary tumor; liver; FNA; cytology Biliary papillomatosis (BP) or intraductal papillary tumor is a rare tumor characterized by multiple papillary adenomas involving extensive areas of the intrahepatic and/or extrahepatic biliary tree, and has a great potential for multicentric malignant transformation. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Preoperative diagnosis is usually difficult. Tumors involving the extrahepatic bile ducts can be confirmed by endoscopic means, including biopsy and brush cytology. For intrahepatic tumors, the imaging techniques often reveal a mass lesion. No diagnostic radiologic features have been documented. 21,22 To our knowledge, fine-needle aspiration (FNA) findings of this rare entity have not been reported. In this study, we describe the FNA cytologic characteristics of 3 cases of BP of the liver, only one of which was correctly diagnosed preoperatively based on the cytology. It appears that the main differential diagnosis in cytology is cholangiocarcinoma; a comparative study is also made. Materials and MethodsThree cases of intrahepatic BP with FNA of the tumor before surgical resection were encountered. The available clinical information was studied. Both the cytologic and histologic sections were reviewed, and their findings were correlated. The cytologic smears of 5 consecutive cases of cholangiocarcinoma (tubular type of adenocarcinoma) confirmed by clinical investigation and/or subsequent excision were reviewed. Their findings were compared to the present 3 cases in an attempt to identify those cytologic features that should allow the recognition of BP.In all cases, the aspiration was performed with ultrasound guidance. Direct smears prepared from the aspirates were wet fixed in 95% ethanol and stained with hematoxylineosin (H&E) and Papanicolaou stains. Tissue fragments aspirated into the syringe and remaining in the needle were rinsed into and fixed in a 7.5% neutral-buffered formalin solution. Cell blocks were prepared with 3% agar as an adjuvant and processed according to a schedule with slightly shortened xylene steps. The standard 4-m sections were stained with H&E.

Biliary papillomatosis: report of seven cases and review of English literature

“…2,11,13 However, the evidence that supports this theory is still scant. Although more than half of the patients reported by authors were from Asian countries, 1,3,4,[7][8][9][11][12][13][14]16 it is not clear whether any racial, geographical, or cultural factors may account for this apparent difference.…”

“…Including this patient, there were altogether four cases in the literature diagnosed incidentally without any typical biliary symptoms. 14,16 It is also our experience that a preoperative diagnosis of biliary papillomatosis could easily be missed at the first instance even if patients presented typically with biliary obstruction and underwent appropriate investigations. 4,19,20 Over the years, special imaging features of biliary papillomatosis were reported using different modalities such as transabdominal ultrasound, computed abdominal tomography, ERCP, magnetic resonance cholangiography, and endoscopic ultrasound.…”

“…All the reported cases since 1993 are summarized in Table 2. 1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]…”

Cystic formations of liver

“…В соответствии с гистологическими характеристиками опухолевых клеток выделяют 4 типа внутрипротоковой папиллярной муци-нозной опухоли: 1) панкреатобилиарный, 2) кишечный, 3) желудочный, 4) онкоцитарный. Чтобы различить эти типы внутрипротоковой папиллярной муцинозной опу-холи, используют иммуногистохимическую диагностику [88], а при сравнении с цитологической картиной ЦА пе-чени можно отметить, что она периодически совпадает с картиной внутрипротоковой папиллярно-муцинозной опухоли поджелудочной железы [82].…”