Long-term growth of intrahepatic papillary neoplasms: A case report

Abstract

BACKGROUNDIntraductal 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 SUMMARYA 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.CONCLUSIONThe development of IPNB should be monitored in patients with cystic lesions and ultrasonography are useful tool for the evaluation.

Cystic liver lesions: a pictorial review

“…21 ). CEUS is very sensitive for the detection of cystic walls or nodule enhancement [ 42 ]. In contrast to intraductal cholangiocarcinoma, enhancement does not increase in the portal and delayed phases [ 44 ].…”

Intrahepatic intraductal papillary cystic neoplasm of the bile duct: A case report

“…Our case was a cystic type IPNB without communication with the biliary tree. Cystic type IPNB has similar imaging features with other cystic liver lesions such as mucinous cystic neoplasms, complicated hepatic cysts, localised Caroli disease [ 13 ]. A communication between the cystic type IPNB and bile duct, or bile duct dilatation can be a clue to differentiate it from other cystic lesions [ 11 ].…”

“…A communication between the cystic type IPNB and bile duct, or bile duct dilatation can be a clue to differentiate it from other cystic lesions [ 11 ]. Hyperenhancement of the cystic wall or nodules in cystic type IPNB is an important finding for evaluating the potential for malignancy [ 13 ].…”

“…IPNB, a precursor lesion with good surgical prognosis, should be distinguished from cholangiocarcinoma. The triad of a local dilation of the bile duct, a nodule within the dilated duct, and a growth along the interior wall of the bile duct on CT or MRI has a positive predictive value above 90% for identifying IPNB vs cholangiocarcinoma [ [13] , [14] ].…”

Lung metastases from intraductal papillary neoplasm of the bile duct: a case report

“…The results indicated that recurrence occurred in 13–29% of cases after curative resection, and this proportion increased to 47–62% if the patient had invasive disease [ 17 – 19 ]. While the classification of IPNB remains complex, meta-analyses and multi-center cohort studies are gradually clarifying the outcomes and prognoses [ 2 , 5 , 6 , 20 , 21 ], and there is also increasing information regarding the surveillance protocols for IPNB and appropriate postoperative follow-up [ 5 , 6 , 22 ]. The present case involved an initial pathological diagnosis of invasive carcinoma with a MUC1-expressing pancreatobiliary type, which is a known prognostic factor.…”