Intraductal papillary neoplasm of extrahepatic biliary tract with an associated early invasive adenocarcinoma

Abstract

Intraductal papillary neoplasm of the bile duct is a premalignant lesion, which can develop into an adenocarcinoma. If treated early, at the non-invasive stage, it has an excellent prognosis compared to cholangiocarcinoma. A 61-year-old female presented with intermittent episodes of fever with chills and rigors, loss of appetite, pruritus, tea colored urine, and pale sticky stools for two years duration. After work up she underwent a left hemihepatectomy with resection of caudate lobe and extrahepatic biliary duct with lymph node clearance. Histology revealed an intraductal papillary lesion with no mucin production, expanding the common hepatic duct and the left hepatic duct, invading the subepithelial connective tissue at a focus near the distal end of the left hepatic duct. The tumor was qualified as an intraductal papillary neoplasia of pancreatobiliary type involving the extrahepatic bile duct with associated early invasive adenocarcinoma. She required no further adjuvant treatment and is disease free for one year on regular followup. The objective of this article is to emphasize the necessity of early diagnosis and aggressive and complete surgical resection to achieve maximum patient survival in this curable disease.