Intrahepatic intraductal papillary mucinous neoplasm (IPNM): Case report

Abstract

Background: IPMN is a rare condition in which the bile ducts are dilated and filled with papillary or villous neoplastic epithelium. IPMNs usually are of pancreatic or extrahepatic origins. Intrahepatic variation of IPMNs is increasingly being reported [4], and a common feature in reported cases is bile duct dilatation. Methods: 65-year-old man was being investigated for iron deficiency anaemia (IDA) and there was an incidental finding of a liver lesion on Commuted Tomography (CT) scan. He was then referred to the Hepatobiliary (HPB) team for management. Following management, his case files including clinic letters, test results, radiological imaging, operative notes, records of admissions and histopathology reports were reviewed for this retrospective case report. Results: At first presentation in the HPB clinic, he was asymptomatic with normal liver function tests and the plan was referral for Multidisciplinary team (MDT) discussion. The case was discussed, and decision was to manage as suspected early cholangiocarcinoma with liver resection. He was electively admitted and had a left lateral sectionectomy. He had an uneventful peri-operative period and discharged home on recovery. Histology reported the specimen as a cystic variant of IPMN arising in intrahepatic bile duct with no evidence of invasive cancer. After this, there was a further discussion at MDT and the plan was for discharge. This happened in follow up clinic, at which time patient remained asymptomatic and well overall. Conclusion: Intrahepatic IPMNs are rare premalignant lesions. There are no specific symptoms, so diagnosis is often post liver resection.