Korean J Hepatobiliary Pancreat Surg.  2013 Feb;17(1):48-52. 10.14701/kjhbps.2013.17.1.48.

Intrahepatic and extrahepatic intraductal papillary neoplasms of bile duct

• Yoon M

• KMID: 2243171
• DOI: http://doi.org/10.14701/kjhbps.2013.17.1.48

Abstract

There has been an increase in the number of reported cases of biliary neoplasm of the hepatobiliary system characterized by markedly dilated and multifocal papillary epithelial lesions of the bile ducts or cystic biliary lesions with or without mucin secretion, and mucinous lesions or tumors, possibly due to recent advances in radiological diagnosis. This lesion of the bile duct is believed to show a better clinical course than non-papillary biliary neoplasm. Therefore, the early recognition and treatment is important. We report two cases of intrahepatic and extrahepatic intraductal papillary neoplasm of the bile duct that were completely resected.

Keyword

Intraductal papillary neoplasm

MeSH Terms

Bile
Bile Ducts
Mucins
Mucins

Figure

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  Fig. 1 Contrast-enhanced CT showing a 3.5×2.5 cm sized rounded soft tissue mass (black arrow) in the proximal common hepatic duct (CHD) and dilated bile ducts (black arrow).

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  Fig. 2 MRI showing 2.6 cm by 3.9 cm sized signal void lesion in the proximal common duct and the dilatations in both IHDs (white arrow).

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  Fig. 3 A microscopic view of papillary growing neoplasm of proximal bile duct composed of elongated villotubulor structure of epithelial cells with extracellular mucin production. (A) H&E, ×40, villotubulor structure of epitherial cells; (B) H&E, ×200, multiple ductules with tall columnar mucinous epithelial cells.

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  Fig. 4 Ultrasound examination showing 7.5×6 cm sized complex cystic mass in left lateral segment of liver with internal solid portion. Contrast-enhanced CT showing a well-defined 7.5×6 cm sized cystic mass with internal debris in the left lateral segment of liver.

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  Fig. 5 A gross (A) and microscopic (B) view of papillary growing intraluminal mass. (A) An encapsulated multilobular cystic mass, filled with clear mucinous fluid. The inner surface of cyst shows multifocal papillary projections. The cut surface of the lesion is heterogeneously solid, yellowish tan and granular. (B) H&E, ×200, Papillary epithelial mass lined by relatively well-oriented columnar shaped epithelial cells with mild nuclear atypism. The cystic wall lined by single layer of mucous cells supported by loose fibrosis without ovarian stroma.

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