J Korean Soc Radiol.  2012 Aug;67(2):113-116. 10.3348/jksr.2012.67.2.113.

Unexpected Metastasis of Intraductal Papillary Mucinous Neoplasm of the Bile Duct into Thoracic Cavity with Direct Extension: Case Report

• Kim ET
• Heo JN
• Park CK
• Choi YW
• Jeon SC

• KMID: 2097960
• DOI: http://doi.org/10.3348/jksr.2012.67.2.113

Abstract

Intraductal papillary mucinous neoplasm (IPMN) is known to arise from intraductal proliferation of mucinous cells with findings of marked dilatation of the biliary or pancreatic duct. There are reports of the metastasis and extension of pancreatic IPMN. However, cases of biliary IPMN with direct metastasis, or metastasis to distant locations, are rare. We present a case of metastasis of biliary IPMN with unexpected direct extension into the thoracic cavity, and we attempt to account for the mechanism of this extension.

MeSH Terms

Bile
Bile Ducts
Dilatation
Mucins
Neoplasm Metastasis
Pancreatic Ducts
Thoracic Cavity
Mucins

Figure

• 

  Fig. 1 The 82-year-old female with biliary intraductal mucinous papilloma with direct extension into the left thoracic cavity. A. Axial CT image shows markedly disproportionally dilatated left intrahepatic duct (arrow) without intramural nodule. B. Coronal CT image reveals the markedly disproportionally dilatated left intrahepatic duct (arrow) without intramural nodule. C. Coronal CT image of the posterior of (B) shows extension to the diaphragm of the dilated bile duct (arrow), the resultant of communication with the left thoracic space leading to empyema (arrowhead). D. Percutaneous transhepatic cholangiography shows disproportionally dilated left intrahepatic duct (arrow) and communication with the left thoracic space (arrowheads).

Reference

1. Kloek JJ, van der Gaag NA, Erdogan D, Rauws EA, Busch OR, Gouma DJ, et al. A comparative study of intraductal papillary neoplasia of the biliary tract and pancreas. Hum Pathol. 2011; 42:824–832.

2. Lim JH, Jang KT, Choi D. Biliary intraductal papillary-mucinous neoplasm manifesting only as dilatation of the hepatic lobar or segmental bile ducts: imaging features in six patients. AJR Am J Roentgenol. 2008; 191:778–782.

3. Lim JH, Yoon KH, Kim SH, Kim HY, Lim HK, Song SY, et al. Intraductal papillary mucinous tumor of the bile ducts. Radiographics. 2004; 24:53–66. discussion 66-67.

4. Kim HJ, Kim MH, Lee SK, Yoo KS, Park ET, Lim BC, et al. Mucin-hypersecreting bile duct tumor characterized by a striking homology with an intraductal papillary mucinous tumor (IPMT) of the pancreas. Endoscopy. 2000; 32:389–393.

5. Yeh TS, Tseng JH, Chiu CT, Liu NJ, Chen TC, Jan YY, et al. Cholangiographic spectrum of intraductal papillary mucinous neoplasm of the bile ducts. Ann Surg. 2006; 244:248–253.

6. Sugiyama M, Atomi Y. Intraductal papillary mucinous tumors of the pancreas: imaging studies and treatment strategies. Ann Surg. 1998; 228:685–691.

7. Jang KT, Kwon GY, Ahn G. Clinicopathological analysis of growth patterns of malignant intraductal papillary mucinous tumors of the pancreas: unusual growth pattern of fistulous extension. Korean J Pathol. 2007; 41:38–43.

8. Shibahara H, Tamada S, Goto M, Oda K, Nagino M, Nagasaka T, et al. Pathologic features of mucin-producing bile duct tumors: two histopathologic categories as counterparts of pancreatic intraductal papillary-mucinous neoplasms. Am J Surg Pathol. 2004; 28:327–338.

9. Rosai J. Rosai and Ackerman's surgical pathology. 2004. Philadelphia: Elsevier;p. 1078–1080.

10. Kaye MD. Pleuropulmonary complications of pancreatitis. Thorax. 1968; 23:297–306.