Case Of Intraductal Papillary Neoplasm Research Articles

Clinicopathological Features of 12 Cases of Intraductal Papillary Neoplasm of the Bile Duct: A Case Series

Clinicopathological Features of 12 Cases of Intraductal Papillary Neoplasm of the Bile Duct: A Case Series

A case of intraductal papillary neoplasm of the bile duct associated with a microinvasive carcinoma

A case of intraductal papillary neoplasm of the bile duct associated with a microinvasive carcinoma

A case of intraductal papillary neoplasm of the bile duct in the periphery of the liver

A case of intraductal papillary neoplasm of the bile duct in the periphery of the liver

S1433 A Rare Case of Intraductal Papillary Neoplasm of the Bile Duct

S1433 A Rare Case of Intraductal Papillary Neoplasm of the Bile Duct

A case of intraductal papillary neoplasm of the bile duct concomitant with double common bile duct

A case of intraductal papillary neoplasm of the bile duct concomitant with double common bile duct

A case of intraductal papillary neoplasm of the bile duct that developed 38\u2009years after choledochoduodenostomy with invasive adenocarcinoma and lymph node metastasis

BackgroundIntraductal papillary neoplasm of the bile duct (IPNB) is a bile duct neoplasm characterized as a precursor lesion of cholangiocarcinoma. An invasive component is present in approximately 40 to 80% of reported cases and lymph node metastasis is sometimes detected. We experienced a rare case of IPNB with invasive adenocarcinoma and lymph node metastasis that developed 38 years after choledochoduodenostomy.Case presentationA 72-year-old man presented to our hospital for liver dysfunction. The patient had a past medical history of choledochoduodenostomy for a bile duct stone 38 years previously and short bowel syndrome because of strangulation ileus 32 years previously.Ultrasonography and abdominal enhanced computed tomography (CT) revealed a left intrahepatic bile duct dilation and a papillary mass in the left hepatic duct. Positron emission tomography (PET) CT showed abnormal accumulation in the left hepatic duct and in the hepatic hilar lymph node. Endoscopic retrograde cholangiogram showed a filling defect in the left bile duct, and a cytological examination revealed the presence of atypical cells.We diagnosed cholangiocarcinoma (derived from IPNB) with lymph node metastasis and performed extended left hepatectomy, caudate lobectomy, and lymph node dissection without extrahepatic bile duct resection.Histopathological findings showed papillary adenoma and partially invasive poorly differentiated adenocarcinoma in the bile duct. Additionally, the hepatic hilar lymph node was positive.ConclusionsThe tumor was diagnosed as IPNB with invasive adenocarcinoma and lymph node metastasis. Biliary tract cancer that develops after choledochoduodenostomy is extremely rare, and only 17 cases (including IPNB) have been reported in the literature.

A case of intraductal papillary neoplasm of the bile duct observed by follow-up ultrasonic examination

A case of intraductal papillary neoplasm of the bile duct observed by follow-up ultrasonic examination

A Case of Intraductal Papillary Neoplasm of the Bile Duct: Invasive Carcinoma That was Diagnosed by Biopsy after Endoscopic Sphincterotomy

症例は75歳，女性．心窩部痛と背部痛で当科受診．肝機能障害があり，MRCPで下部胆管内に総胆管結石を認めた．内視鏡的乳頭切開術（EST）施行時，切開部の十二指腸乳頭部から乳頭状腫瘍を認め，生検施行．病理結果で胆管内乳頭状腫瘍（IPNB）が疑われた．EUSで乳頭部付近の下部胆管内に約１cm大の低エコー腫瘤が描出され，胆道鏡で下部胆管に一部壁不整を認めた．IPNB，下部胆管癌の疑いで亜全胃温存膵頭十二指腸切除術を施行した．病理検査で，周囲正常胆管粘膜から連続し，異型が混在する円柱上皮の一部に腺癌を粘膜内に認めた．免疫染色でMAC5ACとMAC6が染色された．胆管内発育型胆管癌とIPNBの明確な鑑別はないが，IPNB由来の腺癌の可能性が否定できなかった．下部胆管に発生し，EST後の直視下生検によって術前診断しえたIPNB由来の腺癌を経験したので報告する．

Intraductal Papillary Neoplasm of the Bile Duct With Invasive Adenocarcinoma Complicating IgG4-related Sclerosing Cholangitis: Report of a Case

Although there have been many previous studies of IgG4-related SC focusing on the differential diagnosis from cholangiocarcinoma, only a few patients with cholangiocarcinoma against a background of IgG4-related SC have been reported. We herein present a case of intraductal papillary neoplasm of the bile duct (IPNB) associated with invasive carcinoma complicating IgG4-related sclerosing cholangitis. A 71-year-old female with icterus was admitted to a local hospital, where stricture of the extrahepatic bile duct were detected, and subsequently referred to our hospital for possible surgery. Abdominal multidetector-row computed tomography demonstrated marked wall thickening along the entire extrahepatic bile duct. The left lateral superior bile duct (B2) and left lateral inferior duct (B3) were individually obstructed, and percutaneous transhepatic biliary drainage catheters were placed in B2 and B3 separately. The patient was diagnosed to have diffusely spread cholangiocarcinoma and underwent right hepatic trisectionectomy with caudate lobectomy and pancreatoduodenectomy. A histological examination revealed intraductal papillary tumors composed of fibrovascular stalks covered by neoplastic epithelium. Carcinomatous invasion of the papillary tumors was observed in the fibromuscular layer, and there was abundant infiltration of inflammatory cells with fibrosis outside of the cancerous tissue. The inflammatory cells were primarily composed of plasma cells, a majority of which were positive for IgG4 (>30 cells/high-power field); the postoperative serum IgG4 level was 890 mg/dL. Therefore, a diagnosis of coexisting IPNB associated with invasive carcinoma and IgG4-related sclerosing cholangitis was made. To the best of our knowledge, this is the first report of IPNB complicating IgG4-related sclerosing cholangitis.

A Case of Intraductal Papillary Neoplasm with an Associated Invasive Carcinoma

A Case of Intraductal Papillary Neoplasm with an Associated Invasive Carcinoma

Lynch症候群に関連する4重複癌に発症した胆管内乳頭状腫瘍の1例

症例は64歳の男性で，既往歴に上行結腸癌・左腎盂癌がある．2008年，前医のCTで肝内胆管拡張を指摘された．2010年6月，直腸癌・胃癌の精査加療目的に当院紹介受診．胆管拡張は2年前のCTと変化なく，ERC下生検で悪性像は認めなかった．進行直腸癌・胃癌の手術を優先し，胆管腫瘍は慎重な経過観察とした．2011年5月のCTで腫瘍の増大傾向を認め，胆管内乳頭状腫瘍の術前診断で肝左葉切除および尾状葉切除術を行った．病巣は左肝管分岐部から肝管に沿って外側区域全体に及び，さらに左右肝管分岐部に乳頭状病変を認めた．肝管壁にわずかな浸潤を認めた．長い経過から考えて，進行の遅い低悪性度の腫瘍と考えられた．自験例では既往歴および家族歴の聴取により，Lynch症候群を想定することが重要であった．また，限局的な肝内胆管拡張と乳頭状腫瘍を認めた場合，本疾患も念頭に置き，切除適応を考慮する必要がある．

A case of intraductal papillary neoplasm of the bile duct recurred at the remnant lower bile duct after curative liver resection

A case of intraductal papillary neoplasm of the bile duct recurred at the remnant lower bile duct after curative liver resection

A Case of Intraductal Papillary Neoplasm of the Bile duct Diagnosed Using Peroral Cholangioscopy

A Case of Intraductal Papillary Neoplasm of the Bile duct Diagnosed Using Peroral Cholangioscopy

検診にて発見された胆管内乳頭状腫瘍(IPNB)の1例

検診にて発見された胆管内乳頭状腫瘍(IPNB)の1例

Intraductal papillary neoplasm of the bile duct developing in a patient with primary sclerosing cholangitis: A case report

We report a case of intraductal papillary neoplasm of the bile duct (IPNB) that developed in a patient with primary sclerosing cholangitis. A 46-year-old woman was admitted to our hospital with obstructive jaundice. The liver function tests demonstrated increased serum liver enzyme levels. Computed tomography showed dilatation of the intrahepatic bile ducts. Abdominal ultrasonography revealed a highly echoic protruding lesion in the posterior bile duct near the right lobe of the liver. The lesion was suspected to be IPNB, but we were unable to confirm whether it was a carcinoma. A right hepatectomy was performed, and this showed that the dilated bile duct was filled with mucin and contained several yellowish papillary tumors. Histologically, the neoplastic biliary epithelium showed papillary growth in the dilated lumen. The tumor was diagnosed as IPNB, high-grade intraepithelial neoplasia secreting abundant mucin. No recurrence has been detected 3 years after surgery.

根治切除後4年で膵内胆管再発をきたした肝門部原発胆管IPNの1例

胆管IPN（IPNB:intraductal papillary neoplasm of bile duct）は乳頭状発育を示す胆道腫瘍であり，病理学的な相同性から膵IPMNのカウンターパートと考えられている．症例は76歳の女性で，肝門部原発胆管腫瘍の診断のもと肝左葉切除術，尾状葉切除術，肝外胆管切除術を施行した．腫瘍は組織学的に非浸潤性乳頭腺癌であり，腫瘍の表層拡大や胆管断端浸潤は認めなかった．術後4年目に腹部CTで遺残膵内胆管に再発を認め，膵頭十二指腸切除術を施行した．現在のところ再発を認めていない．本症例のように，胆管IPNは治癒切除後もしばし遺残胆管に再発することを念頭に置き，CT等の画像検査を含めた長期フォローが必要である．

A case of intraductal papillary neoplasm of bile duct diagnosed by the biopsy after EST

A fifty-year-old woman complaining of back pain and nausea since June 2012 was referred to our hospital. Blood analysis showed high levels of hepatobiliary enzymes and abdominal US identified dilatation of the common bile duct. CT scan and MRCP showed stricture of the lower bile duct by a papillary tumor, while EUS and IDUS images showed a hyper echoic papillary tumor in the lower bile duct. Brushing cytology at the stricture segment of the lower bile duct revealed a class III lesion, so ERCP was repeated. Following observation of the papillary tumor using SpyGlass, a whitish papillary tumor of the lower bile duct was exposed at the papilla of Vater after EST, and biopsy of the tumor was performed. Histological examination showed a tubular adenocarcinoma, and lower bile duct cancer (Stage I) was diagnosed. The patient underwent surgery, and final diagnosis by histology was intraductal papillary neoplasm with an associated invasive carcinoma (IPNB, intestinal type).

A case of intraductal papillary neoplasm of the bile duct co-existing with bile duct hamartoma

A case of intraductal papillary neoplasm of the bile duct co-existing with bile duct hamartoma

胆管内乳頭状腫瘍(IPNB)の1例

胆管内乳頭状腫瘍(IPNB)の1例

Clinicopathologic and immunohistochemical study of 187 cases of intraductal papillary neoplasm of breast

To evaluate the diagnostic approach and criteria for intraductal papillary neoplasms of breast. According to the criteria of 2003 WHO classification, 187 cases of intraductal papillary neoplasm of breast were identified and enrolled into the study. The clinical and histologic features were reviewed and immunohistochemical study for CD10, p63, CK14, CK5/6, CK7, MGB1 and p53 were carried out on 53 cases. Amongst the 187 cases studied, there were 128 cases of intraductal papilloma, 16 cases of atypical intraductal papilloma and 43 cases of intraductal papillary carcinoma. They showed a spectrum of morphologic features including epithelial and stromal hyperplasia and secondary changes. The expression of myoepithelial markers, including CD10 and p63, significantly decreased in ascending order from intraductal papillomas, atypical intraductal papillomas and intraductal papillary carcinomas (P < 0.001). The expression of basal cell markers, including CK5/6 and CK14, showed a mosaic pattern in benign lesions and significantly decreased or was absent in atypical and carcinomatous lesions (P < 0.001). In contrast, the luminal cell marker CK7 expressed in the three groups with no statistically significant difference (P = 0.06). On the other hand, the expression of MGB1 in intraductal papillary carcinomas was much lower than that in the other two groups (P = 0.002 and P = 0.007). The staining for p53 was negative in all of the three groups. Intraductal papillary neoplasms of breast represent a heterogeneous group of lesions with various morphologic appearances. Correlation with immunostaining results for myoepithelial markers, basal-type cytokeratins and luminal epithelial markers are helpful in arriving at a definitive diagnosis.