Malignant Papillary Neoplasms of the Intrahepatic Bile Ducts

Yoon, Kwon‐Ha; Ha, Hyun Kwon; Kim, Chang Ghun; Roh, Byung Suk; Yun, Ki Jung; Chae, Kwon Mook; Lim, Jae Hoon; Auh, Yong Ho

doi:10.2214/ajr.175.4.1751135

Cited by 44 publications

(35 citation statements)

References 11 publications

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“…In some BDC patients, carcinoma spreads from the main tumor lesion along the bile duct epithelium with wide extension (3,4). This tumor extension represents a serious obstacle to obtaining curative surgical resection when the carcinoma remains at the cut end of the bile duct (5).…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Bile Duct Carcinoma with Superficial Extension in the Epithelium

et al. 2009

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Section: Introductionmentioning

confidence: 99%

Characteristics of Bile Duct Carcinoma with Superficial Extension in the Epithelium

et al. 2009

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“…10 The clinical characteristics of IPNB are not fully defined, but a good prognosis following complete surgical resection of the tumor is expected based on the results for IPMN of the pancreas. 1,2,15,16 In IPNB, solid, irregular, or thickened lesions in the cystic or dilated bile duct are considered evidence of malignancy, [2][3][4][5][6]11,17 but these malignant components might not be observed at the stage of dysplasia or in situ carcinoma. 1,2,7,14 In the present study, we report a rare case of an elderly female patient with progressive dilatation of the right intrahepatic bile ducts; the patient underwent extended right hemihepatectomy with extrahepatic bile duct resection for superficially continuous extension.…”

Section: Introductionmentioning

confidence: 99%

Intraductal papillary neoplasm of the bile duct extending superficially from the intrahepatic to extrahepatic bile duct

et al. 2006

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Intraductal papillary neoplasm of the bile duct (IPNB) or liver is a recently noted rare disease, and its pathogenesis remains unclear. Here we present a case of IPNB with an interesting morphology, which was treated by resection of the right hemiliver and extrahepatic bile duct. A 79-year-old woman was found to have a high alkaline phosphatase level and slight dilatation of the right intrahepatic bile duct on imaging studies. The right intrahepatic bile duct became dilated over a 2-year period; however, no solid mass could be detected, and tumor markers were not elevated. Hepatic resection was scheduled because a mucin-producing bile duct carcinoma of the liver was suspected. A right hemihepatectomy was conducted, and the extrahepatic bile duct was also resected after malignant cells were found in the surgical stump of the right bile duct and in the bile itself. Macroscopically, diffuse dilatation of the intrahepatic bile duct was noted, but no solid component or mucin within the duct was found. Histopathological findings revealed carcinoma in situ, IPNB, in the majority of intrahepatic bile ducts, with no lymph node metastasis, and it extended continuously to the epithelium of the common bile duct. No tumor recurrence or biliary dilatation was observed at follow-up 2 years after surgery. It is important to consider malignancy in the presence of a dilated bile duct and in the absence of any cause of occlusion. Complete resection of IPNB results in a good prognosis and no recurrence.

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“…The ability to localize a tumor is essential for surgical planning. However, papillary tumors are usually small, sessile, or spread along the mucosal surface, making them sometimes difficult or impossible to detect with any of the currently used imaging modalities (3)(4)(5)(6)(7)(8). In our study, it was not easy to detect a small mass on contrast-enhanced transverse CT and MRI, at first glance.…”

Section: Discussionmentioning

confidence: 50%

“…Some papillary tumors of the bile ducts produce a large amount of mucin, similar to IPMT of the pancreas in terms of histopathology, production of excessive mucin, and pathophysiology (3)(4)(5)(6)(7)(8). Sonography, CT, and MRCP show severe dilatation of the intra-and extrahepatic ducts with or without a mass in the ducts.…”

Section: Discussionmentioning

confidence: 93%

Gadobenate dimeglumine–enhanced MRI of intraductal papillary mucinous tumor of the bile ducts

Park

Lee

et al. 2007

Magnetic Resonance Imaging

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We present the case of a 63-year-old male with intraductal papillary mucinous tumor (IPMT) of the bile ducts. We discuss the role of gadobenate dimeglumine (Gd-BOPTA)-enhanced T1-weighted MRI in the visualization of mucin flow, localization of the papillary tumor, and confirming the diagnosis of this uncommon disease. MAGNETIC RESONANCE cholangiopancreatography (MRCP) is a noninvasive method for visualizing the pancreatobiliary ductal systems. For conventional MRCP, heavily T2-weighted, fat-suppressed sequences are used, in which the static fluid has a hyperintense signal and the signals of the background, solid mass, and calculi are suppressed.Gadobenate dimeglumine (Gd-BOPTA, MultiHance; Bracco Imaging, Milan, Italy), a new gadolinium-based contrast agent, differs from conventional gadoliniumbased agents in that it possesses a two-fold greater T1 relaxivity in human plasma and it is eliminated from the body through both the renal (95-97% of the injected dose) and hepatobiliary (3-5% of the injected dose) pathways (1,2). Hepatobiliary elimination appears to occur as a result of functioning hepatocytes taking up the Gd-BOPTA chelate of Gd-BOPTA and eliminating it via an anionic transporter across the sinusoidal membrane into the bile (1,2). Therefore, Gd-BOPTA has the potential to generate anatomical and functional T1-weighted MR cholangiographic images. However, its effects on intraductal papillary mucinous tumor (IPMT) of the bile ducts have not yet been explored.The aim of this study was to evaluate the usefulness of Gd-BOPTA-enhanced MR cholangiography in the evaluation of IPMT of the bile ducts. CASE REPORTA 63-year-old man was admitted to our hospital for further evaluation of a bile duct dilatation that was detected incidentally during a routine checkup.Contrast-enhanced computed tomography (CT) scans were performed with a 16-detector row scanner (Somatom Sensation 16, software version VA20; Siemens Medical Solutions, Forchheim, Germany) with the following parameters: detector collimation of 16 ϫ 0.75, table feed of 12 per rotation, section width of 5 mm, reconstruction increment of 5 mm with 5-mm sections, pitch of 1.2; tube current of 120 kVp (phased kilovolts); and 160 mA. Portal phase CT imaging showed severe dilatation of the right and left intrahepatic ducts (Fig. 1a).MRI was performed with a 1.5-T superconducting unit (Magnetom Vision; Siemens Medical Systems, Erlangen, Germany) and a phased-array torso coil. Routine MR cholangiographic sequences were performed using a half-Fourier rapid acquisition with a relaxation enhancement (RARE) sequence with breathholds (TR/ effective TE ϭ infinite/95 msec; matrix size ϭ 240 ϫ 256; field of view ϭ 300 -350 mm). We performed sequential multisection acquisitions (section thickness ϭ 3-5 mm). Dynamic contrast-enhanced MRI was performed using, 3D T1-weighted, fat-saturated, volumetric interpolated breathhold images (VIBE) (TR/TE ϭ 4.2 msec/1.6 msec; flip angle ϭ 12°; matrix size ϭ 205 ϫ 256; field of view ϭ 300 -350 mm; and 24 partitions interpolated to 48 slic...

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Malignant Papillary Neoplasms of the Intrahepatic Bile Ducts

Cited by 44 publications

References 11 publications

Characteristics of Bile Duct Carcinoma with Superficial Extension in the Epithelium

Characteristics of Bile Duct Carcinoma with Superficial Extension in the Epithelium

Intraductal papillary neoplasm of the bile duct extending superficially from the intrahepatic to extrahepatic bile duct

Gadobenate dimeglumine–enhanced MRI of intraductal papillary mucinous tumor of the bile ducts

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