Long-term observation and treatment of a widespread intraductal papillary neoplasm of the bile duct extending from the intrapancreatic bile duct to the bilateral intrahepatic bile duct: A case report

Hokuto, Daisuke; Nomi, Takeo; Yasuda, Satoshi; Yoshikawa, Takahiro; Ishioka, Kohei; Yamada, Takatsugu; Akahori, Toshikazu; Nakagawa, Kenji; Nagai, Minako; Nakamura, Kota; Obara, Shinsaku; Kanehiro, Hiromichi; Sho, Masayuki

doi:10.1016/j.ijscr.2017.07.031

Cited by 11 publications

(8 citation statements)

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“…Some are limited to one part of the biliary tree, while others extend continuously for a considerable length and area over the bile duct mucosa [ 2 , 3 , 5 , 37 ]. Several cases have shown widespread extension [ 89 ]. According to the study by Kim et al [ 37 , 90 ], 35% of cases were of polypoid appearance, 23% of cast-like, 28% of superficial spreading and the remaining 15% of cyst-forming type.…”

Section: Pathologies Of Ipnbsmentioning

confidence: 99%

“…More than one-third of IPNBs (about 40%) show mucin hypersecretion, and the mucin layer covers the papillary lesions and fills the bile duct lumen [ 31 , 37 , 66 , 89 , 96 ]. Mucin hypersecretion is more frequently observed in intrahepatic IPNBs than in extrahepatic IPNBs [ 2 , 37 ].…”

Section: Pathologies Of Ipnbsmentioning

confidence: 99%

“…Neoplastic epithelial cells display a spectrum of cytoarchitectural atypia ranging from none to borderline or even overt malignant changes, and invasive carcinoma can also be associated with IPNB [ 2 , 44 , 67 , 89 ]. A two-tiered grading system of low-grade dysplasia versus high-grade dysplasia, mainly based on these atypia, particularly nuclear changes, is applied to IPNB in order to delineate clinically significant examples from the insignificant ones [ 2 , 3 , 16 ].…”

Section: Pathologies Of Ipnbsmentioning

confidence: 99%

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Intraductal Papillary Neoplasm of Bile Duct: Updated Clinicopathological Characteristics and Molecular and Genetic Alterations

Nakanuma

Uesaka

Kakuda

et al. 2020

JCM

113

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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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Section: Pathologies Of Ipnbsmentioning

confidence: 99%

Section: Pathologies Of Ipnbsmentioning

confidence: 99%

Section: Pathologies Of Ipnbsmentioning

confidence: 99%

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Intraductal Papillary Neoplasm of Bile Duct: Updated Clinicopathological Characteristics and Molecular and Genetic Alterations

Nakanuma

Uesaka

Kakuda

et al. 2020

JCM

113

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“… 15 It has been proposed that the curative resection of IPNB with a malignant potential has a favorable prognosis of 47.0–82.0% 5-year overall survival rate. 16 17 18 However, microscopic positive margin (R1 resection), invasive carcinoma, extraductal invasion, lymphovascular invasion, lymph node metastasis, tumor positivity for Mucin-1, and positivity for carcinoembryonic antigen (CEA) are poor prognostic factors with higher incidence of recurrence after surgical resection of IPNB. 18 19 Mucus production can occur after surgical resection, even if no malignant IPNB tissue remains.…”

Section: Discussionmentioning

confidence: 99%

A huge intraductal papillary neoplasm of the bile duct treated by right trisectionectomy after right portal vein embolization

Aliyev

Yasuchika

Hammad

et al. 2018

Ann Hepatobiliary Pancreat Surg

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Intraductal papillary neoplasm of the bile duct (IPNB) is a rare variant of bile duct tumors characterized by papillary growth within the bile duct lumen and recognized precursor of invasive carcinoma. IPNB was detected incidentally in a 60-year-old woman during check up. Radiologic images revealed a huge cystic mass with papillary projection and markedly dilated bile ducts. Biopsies revealed high-grade IPNB. Cholangioscopy detected a connection between the right posterior bile duct and cyst lumen with epithelial dysplasia of the bile duct. Right posterior sectional duct opened in the left hepatic duct. Consequently, right trisectionectomy and extrahepatic bile duct resection were conducted. Histological studies revealed intraductal papillary neoplasm with high-grade intraepithelial neoplasia (carcinoma in situ). IPNB patients without distant metastases are candidates for surgery and complete resection should be conducted to achieve long-term survival.

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“…In 2008, the concept of IPMN-B was first proposed to summarize such diseases (Paik et al, 2008). There is limited understanding of IPMN-B, which are mostly case reports, and lack of large-scale clinical research (Nakanuma et al, 2016;Hokuto et al, 2017). This study retrospectively analyzed 58 patients with IPMN-B admitted in our hospital from January 2012 to August 2017.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological findings and imaging features of intraductal papillary neoplasms in bile ducts

Zhang

Zhong

Kong

et al. 2020

PeerJ

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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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Long-term observation and treatment of a widespread intraductal papillary neoplasm of the bile duct extending from the intrapancreatic bile duct to the bilateral intrahepatic bile duct: A case report

Cited by 11 publications

References 12 publications

Intraductal Papillary Neoplasm of Bile Duct: Updated Clinicopathological Characteristics and Molecular and Genetic Alterations

Intraductal Papillary Neoplasm of Bile Duct: Updated Clinicopathological Characteristics and Molecular and Genetic Alterations

A huge intraductal papillary neoplasm of the bile duct treated by right trisectionectomy after right portal vein embolization

Clinicopathological findings and imaging features of intraductal papillary neoplasms in bile ducts

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