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1
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Kraus M, Klang E, Soffer S, Inbar Y, Konen E, Sobeh T, Apter S. MRI features of intraductal papillary mucinous neoplasm of the bile ducts, "The myth about the cyst": A systematic review. Eur J Radiol Open 2023; 11:100515. [PMID: 37609049 PMCID: PMC10440390 DOI: 10.1016/j.ejro.2023.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/03/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Rationale and objectives Intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is a true pre-cancerous lesion, which shares common features with pancreatic IPMN (IPMN-P). While IPMN-P is a well described entity for which guidelines were formulated and revised, IPMN-B is a poorly described entity.We carried out a systematic review to evaluate the existing literature, emphasizing the role of MRI in IPMN-B depiction. Materials and methods PubMed database was used to identify original studies and case series that reported MR Imaging features of IPMN-B. The search keywords were "IPMN OR intraductal papillary mucinous neoplasm OR IPNB OR intraductal papillary neoplasm of the bile duct AND Biliary OR biliary cancer OR hepatic cystic lesions". Risk of bias and applicability were evaluated using the QUADAS-2 tool. Results 884 Records were Identified through database searching. 12 studies satisfied the inclusion criteria, resulting in MR features of 288 patients. All the studies were retrospective. Classic features of IPMN-B are under-described. Few studies note worrisome features, concerning for an underlying malignancy. 50 % of the studies had a high risk of bias and concerns regarding applicability. Conclusions The MRI features of IPMN-B are not well elaborated and need to be further studied. Worrisome features and guidelines regarding reporting the imaging findings should be established and published. Radiologists should be aware of IPMN-B, since malignancy diagnosis in an early stage will yield improved prognosis.
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Affiliation(s)
- Matan Kraus
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel
- Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yael Inbar
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamer Sobeh
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Apter
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Gelders F, Struyve M, van Malenstein H. Biliary papillomatosis. Acta Gastroenterol Belg 2023; 86:483-485. [PMID: 37814564 DOI: 10.51821/86.3.11733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Biliary papillomatosis (BP) is a rare disorder of the biliary tract characterized by the presence of multiple papillary adenomas spread along the biliary tree. Although benign, it carries a significant risk of malignant transformation. Due to low sensitivity and specificity of conventional radiologic modalities, the diagnosis as well as estimation of disease extent is difficult. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreaticography (ERCP) are superior although direct peroral cholangioscopy (POC) is currently the most accurate diagnostic method. Mainly because it provides more detailed information and makes targeted histological diagnosis possible. The treatment of biliary papillomatosis consists of surgical resection, liver transplantation (LT) or a combination of both. Unfortunately, the recurrence rate after radical surgery without LT remains high due to the diffuse distribution of the disease.
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Affiliation(s)
- F Gelders
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, Leuven, Belgium
| | - M Struyve
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium
| | - H van Malenstein
- Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, Leuven, Belgium
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3
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Xia Y, Guo H, Ma H. Hepatobiliary diseases. Eur J Intern Med 2023; 110:95-96. [PMID: 36635130 DOI: 10.1016/j.ejim.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Yuanhao Xia
- School of Medical Imaging, Binzhou Medical University, Yantai, China; Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, China
| | - Hao Guo
- Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, China
| | - Heng Ma
- School of Medical Imaging, Binzhou Medical University, Yantai, China; Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, China.
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4
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Tringali A, Milluzzo SM, Ardito F, Laurenzi A, Ettorre GM, Barbaro B, Ricci R, Giuliante F, Boškoski I, Costamagna G. Peroral-cholangioscopy to plan surgery for protruding biliary lesions: report of four cases. Ther Adv Gastrointest Endosc 2022; 15:26317745221139735. [PMID: 36465430 PMCID: PMC9709184 DOI: 10.1177/26317745221139735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/17/2022] [Indexed: 01/11/2024] Open
Abstract
Intraductal biliary lesions can involve the main hepatic confluence. Assessment of the extension of pedunculated biliary lesions during per-oral cholangioscopy (POCS) can optimize and personalize the surgical strategy. Four consecutive cases of pedunculated biliary lesions were analysed. Cholangioscopy was performed with a disposable single-operator cholangioscope. POSC was successfully performed in four patients (three female, mean age 50 years), showing involvement of the main biliary confluence in three of four pedunculated biliary lesions; direct biopsy sampling was diagnostic in two of three cases (in one patient, biopsy were not performed due to the smooth appearance of the intrabiliary lesion). No adverse events occurred after POCS. Surgery required excision of the main hepatic confluence in two of three cases (one patient was not resectable). POCS can diagnose intrabiliary extension of protruding biliary lesions, providing important information to plan the surgical intervention.
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Affiliation(s)
- Andrea Tringali
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy Centre for Endoscopic Research Therapeutics and Training (CERTT), Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy
| | - Sebastian Manuel Milluzzo
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Francesco Ardito
- Hepato-Biliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli” IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Laurenzi
- General Surgery and Transplantation Unit San Camillo-Forlanini Hospital and National Institute of Infectious Disease ‘Lazzaro Spallanzani’ IRCCS, Rome, Italy
| | - Giuseppe Maria Ettorre
- General Surgery and Transplantation Unit San Camillo-Forlanini Hospital and National Institute of Infectious Disease ‘Lazzaro Spallanzani’ IRCCS, Rome, Italy
| | - Brunella Barbaro
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Ricci
- UOC di Anatomia Patologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Felice Giuliante
- Hepato-Biliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli” IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centre for Endoscopic Research Therapeutics and Training (CERTT), Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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5
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Tang W, Qiu JG, Wei XF, Xiao H, Deng X, Wang SD, Du CY, Wu Q. Endoscopic Endoluminal Radiofrequency Ablation and Single-Operator Peroral Cholangioscopy System (SpyGlass) in the Diagnosis and Treatment of Intraductal Papillary Neoplasm of the Bile Duct: A Case Report and Literature Review. Front Med (Lausanne) 2021; 8:675720. [PMID: 34604248 PMCID: PMC8481375 DOI: 10.3389/fmed.2021.675720] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/23/2021] [Indexed: 01/15/2023] Open
Abstract
Background: Intraductal papillary neoplasm of the bile duct (IPNB) is a rare biliary benign tumor with atypical clinical features and is frequently misdiagnosed. Its treatment is limited and surgical resection is thought to be the only therapeutic option in patients with IPNB. With the aim of increasing the early diagnosis rate of IPNB and providing more therapeutic options for surgeons, we innovatively put forward the concept of combined utilization of SpyGlass and endoscopic endoluminal radiofrequency ablation (ERFA) in the diagnosis and treatment of IPNB. Case Presentation: An 85-year-old woman was referred to our hospital due to right upper quadrant abdominal pain. The image examinations indicated suspicious filling defects at the upper common bile duct. Further evaluation of SpyGlass cholangioscopy showed multiple reddish villous lesions at the left hepatic duct, and SpyBite biopsy under direct visualization demonstrated papillary low-grade dysplasia. In consideration of the advanced age and preference of the patient, the novel ERFA therapy was performed. The procedure was successful without periprocedural complications; the patient recovered uneventfully and was discharged 2 days after the operation. Upon follow-up, the patient was asymptomatic and in good physical condition at 8 months postoperatively. Conclusion: Preliminarily, we demonstrate that the strategy of a combination of SpyGlass and ERAF seems to be a promising, feasible, well-tolerated, and safe management for patients with IPNB. However, more data with larger patient volumes are needed to evaluate its outcomes further.
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Affiliation(s)
- Wei Tang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Jian-Guo Qiu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu-Fu Wei
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Heng Xiao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Deng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shao-Dong Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cheng-You Du
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiao Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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6
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Wu C, Yang JF, Zhang Q, Liu W, Liao K, Hu B. Successful cholangioscopic electrocoagulation for biliary papillomatosis: Report covering six cases (with video). GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 44:546-551. [PMID: 33617929 DOI: 10.1016/j.gastrohep.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/29/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biliary papillomatosis is a rare type of papillomatosis. Depending on the location of the disease, radical surgical resection or liver transplants are the treatment of choice. These radical surgical options may be unrealistic in patients who are not surgical candidates or who are unwilling to consider surgery. AIMS To evaluate the effectiveness of endoscopic electrocoagulation for the biliary papillomatosis. METHODS In this case series, we report six patients with unresectable biliary papillomatosis who underwent cholangioscopic electrocoagulation using needle knife and their clinic follow up information. RESULTS After patients received cholangioscopy with electrocoagulation of the residual biliary papilloma, the daily T-tube drainage volume increased to 200-400ml with improvement in the drainage content and significant relief of clinical symptoms, such as jaundice and abdominal pain. CONCLUSION This method of using electrocoagulation to directly target and destroy tumor tissue is a safe and effective alternative for those with unresectable disease, and this method has shown to enhance T-tube drainage volume and improve patients' overall clinical symptoms.
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Affiliation(s)
- Chuncheng Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Juliana F Yang
- Department of Internal Medicine, Division of Digestive and Liver Diseases, The Vanderbilt University Medical Center, Nashville, TN, USA
| | - Qiongying Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Wei Liu
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Ke Liao
- Department of Gastroenterology, West China Hospital, Sichuan University, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, China.
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7
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Sakai Y, Ohtsuka M, Sugiyama H, Mikata R, Yasui S, Ohno I, Iino Y, Kato J, Tsuyuguchi T, Kato N. Current status of diagnosis and therapy for intraductal papillary neoplasm of the bile duct. World J Gastroenterol 2021; 27:1569-1577. [PMID: 33958844 PMCID: PMC8058653 DOI: 10.3748/wjg.v27.i15.1569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/13/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Bile duct epithelial tumours showing papillary neoplasm in the bile duct lumen are present in the intrahepatic and extrahepatic bile ducts. Clinicopathological images of these tumours are distinctive and diverse, including histological images with a low to high grade dysplasia, infiltrating and noninfiltrating characteristics, excessive mucus production, and similarity to intraductal papillary mucinous neoplasm (IPMN) of the pancreas. The World Health Organization Classification of Tumours of the Digestive System in 2010 named these features, intraductal papillary neoplasm of the bile duct (IPNB), as precancerous lesion of biliary carcinoma. IPNB is currently classified into type 1 that is similar to IPMN, and type 2 that is not similar to IPMN. Many of IPNB spreads superficially, and diagnosis with cholangioscopy is considered mandatory to identify accurate localization and progression. Prognosis of IPNB is said to be better than normal bile duct cancer.
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Affiliation(s)
- Yuji Sakai
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Harutoshi Sugiyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Rintaro Mikata
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Shin Yasui
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Izumi Ohno
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Yotaro Iino
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Jun Kato
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Toshio Tsuyuguchi
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Naoya Kato
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
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8
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Choi JU, Hwang S, Jung DH, Park GC, Ahn CS, Kim KH, Moon DB, Ha TY, Song GW, Lee SG. Living donor liver transplantation for diffuse biliary papillomatosis with malignant change: A case report with 10-year follow-up. Ann Hepatobiliary Pancreat Surg 2020; 24:209-215. [PMID: 32457269 PMCID: PMC7271106 DOI: 10.14701/ahbps.2020.24.2.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 12/08/2022] Open
Abstract
Biliary papillomatosis is a rare disease of the biliary tract. In this study, we present a case of a male patient with biliary papillomatosis with malignant change who underwent living donor liver transplantation (LDLT). The 49-year-old man was admitted due to intrahepatic ductal mass, which was finally diagnosed as biliary papillomatosis. It was initially treated by photodynamic therapy, but LDLT was planned due to low efficacy of photodynamic therapy. LDLT was performed with a right liver graft from his son. The pathology report revealed intraductal papillary neoplasm with associated invasive carcinoma. He recovered uneventfully. Although the distal bile duct resection margin was free of tumor, the risk of tumor recurrence at the remnant intrahepatic bile duct still remained. Therefore, staged pylorus-preserving pancreatoduodenectomy was planned. However, after 3 months, he was readmitted due to retropancreatic abscess. It took 6 months to control the intractable retropancreatic abscess. Due to late development of retropancreatic abscess and its slow recovery, staged pancreatoduodenectomy was no longer considered. The patient recovered complete at 1 year posttransplant without any evidence of disease recurrence. After 5 years posttransplant, lung metastasis developed and pulmonary metastasectomy was performed three times. No further recurrence developed during the last 3 years to date, and the patient currently is alive, 10 years after the LDLT. Experience on our case and literature review suggest that patients with biliary papillomatosis with or without malignant transformation are selectively indicated for liver transplantation.
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Affiliation(s)
- Jin Uk Choi
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok-Bog Moon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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9
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Ferraro D, Levi Sandri GB, Vennarecci G, Santoro R, Colasanti M, Meniconi RL, Lepiane P, Ettorre GM. Successful Orthotopic Liver Transplant for Diffuse Biliary Papillomatosis With Malignant Transformation: A Case Report With Long-Term Follow-Up. EXP CLIN TRANSPLANT 2019; 17:835-837. [PMID: 29534660 DOI: 10.6002/ect.2017.0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
In patients with biliary papillomatosis, complete resection of the biliary tree (that is, liver transplant along with duodenocephalo-pancreatectomy) is considered the only potential curative treatment, given its diffuse pattern and likelihood of malignant transformation. Nevertheless, such a combined surgical approach can increase patient morbidity and mortality and should be considered only when the distal part of the common bile duct is involved. Here, we avoided duodenocephalo-pancreatectomy in a patient with distal common bile duct free from disease; this approach did not negatively influence survival and appeared to be safer during liver transplant.
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Affiliation(s)
- Daniele Ferraro
- From the General Surgery and Organ Transplantation Unit, San Camillo Hospital, Rome, Italy
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10
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Zheng Q, Ruan SM, Shan QY, Xu M, Chen LD, Hu HT, Huang Y, Xie XY, Lu MD, Liao B, Wang W. Clinicopathological findings and imaging features of intraductal papillary neoplasm of the bile duct: comparison between contrast-enhanced ultrasound and contrast-enhanced computed tomography. Abdom Radiol (NY) 2019; 44:2409-2417. [PMID: 31093728 DOI: 10.1007/s00261-019-01987-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Intraductal papillary neoplasms of the bile duct (IPNBs) are a group of rare lesions with uncertain clinical findings and imaging features. We aim to investigate the clinicopathological features and imaging findings of IPNBs on contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT). METHODS From February 2005 to March 2018, 30 patients with pathologically confirmed IPNBs were retrospectively identified in our hospital. Demographic, clinical, and pathological data, CEUS and CECT features and surgical strategies were analyzed. RESULTS The most common clinical manifestations were abdominal pain (53.3%), jaundice (23.3%), and acute cholangitis (10.0%). Among all lesions, 5/30 (16.7%) lesions presented as dilated bile ducts only, while 13/30 (43.3%) lesions presented as dilated bile ducts with intraductal papillary masses, and 12/30 (40.0%) presented as solid masses with dilated bile ducts. For the 20 patients who underwent both CEUS and CECT, 18 lesions were hyperenhanced on CEUS, and 17 lesions were hyperenhanced on CECT in the arterial phase. In total, 16 and 18 lesions showed washout in the portal and late phases on CEUS, while the corresponding number of lesions that showed washout in the portal and late phases on CECT were 11 and 13. Twelve lesions (40.0%) showed atypical hyperplasia, while 16/30 (53.3%) lesions underwent malignant transformations. CONCLUSIONS There are 3 major forms of IPNBs on grayscale ultrasound, including diffusely dilated bile ducts without visible mass; focal dilated bile duct with intraductal papillary masses; and solid mass surrounded by dilated bile ducts. The enhancement patterns of IPNBs on CEUS and on CECT were consistent. IPNB has a high malignant potential, and patients should be treated with surgical resection after the diagnosis is established.
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Affiliation(s)
- Qiao Zheng
- Department of Medical Ultrasonics, Fetal Medical Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Si-Min Ruan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Quan-Yuan Shan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Ming Xu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Li-Da Chen
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Yang Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Bing Liao
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China.
| | - Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.
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11
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Xiao Y, Zhao J, Wu H, Xie KL, Wan Y, Xu XW, Zhang YG. Surgical treatment of malignant biliary papillomatosis invading adjacent organs: A case report. World J Clin Cases 2019; 7:253-259. [PMID: 30705903 PMCID: PMC6354098 DOI: 10.12998/wjcc.v7.i2.253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/19/2018] [Accepted: 12/30/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Biliary papillomatosis (BP) is a rare disease characterized by multiple papillary adenomas in the intrahepatic and extrahepatic biliary tree and has a high risk of malignant transformation. Early diagnosis and treatment for BP are challenges, as it spreads along the biliary tract. A radical resection with an adequate resection margin is advocated in patients with malignant BP.
CASE SUMMARY We report a case of BP with malignant transformation in a 52-year-old female patient who presented with emaciation, severe malnutrition, and a T-tube for biliary drainage that was placed for almost 2 years at the time she visited us. The enhanced magnetic resonance imaging of the upper abdomen revealed a neoplasm with a diameter of 15 cm located in the gallbladder area surrounding the common bile duct where a drainage tube was placed. It was the first case with malignant BP involving multiple organs and the abdominal wall and receiving a radical resection. Plastic surgeons helped close the incision by transferring the rectus muscle and external oblique muscle flap. A diagnosis of papillary carcinoma with diffuse malignant papillomatosis of the biliary duct was given. The postoperative course was uneventful and she was asymptomatic and in good physical condition at 35 mo postoperatively with appropriate chemotherapy.
CONCLUSION Aggressive surgical treatment with appropriate chemotherapy is advocated for patients with malignant BP even if multiple organ invasion is present.
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Affiliation(s)
- Yang Xiao
- Department of Plastic and Burn Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Juan Zhao
- Department of Plastic and Burn Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hong Wu
- Kun-lin Xie, Department of Liver Surgery/Liver Transplantation, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | | | - Ying Wan
- Department of Pathology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xue-Wen Xu
- Department of Plastic and Burn Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan-Ge Zhang
- Department of Plastic and Burn Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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Chua D, Chiow AKH, Ang TL, Wang LM. Malignant Transformation Arising Within Unusual and Rare Hepatic Lesions: Fibropolycystic Disease Form of Ductal Plate Malformation and Biliary Adenofibroma. Int J Surg Pathol 2018; 26:542-550. [PMID: 29464972 DOI: 10.1177/1066896918758172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
Cholangiocarcinoma is the second most common hepatobiliary cancer following hepatocellular carcinoma, and 20% to 25% are intrahepatic. We describe 2 cases of intrahepatic cholangiocarcinoma arising within unusual and rare hepatic lesions, fibropolycystic liver disease form of ductal plate malformation and biliary adenofibroma, whose association with malignancy is rarely reported in the literature.
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Affiliation(s)
- Darren Chua
- 1 Changi General Hospital SingHealth, Singapore, Singapore
| | | | | | - Lai Mun Wang
- 1 Changi General Hospital SingHealth, Singapore, Singapore
- 2 Ludwig Institute, University of Oxford Nuffield Department of Medicine, Oxford, England
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13
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Kohli DR, Shah TU. Board Review Vignette: Intraductal Papillary Neoplasm of the Bile Duct. Am J Gastroenterol 2018; 113:639-641. [PMID: 29497137 DOI: 10.1038/s41395-018-0009-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/21/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA. Division of Gastroenterology and Hepatology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Tilak U Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA. Division of Gastroenterology and Hepatology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
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14
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Gu C, Lin YE, Jin H, Jian Z. Biliary papillomatosis with malignant transformation: A case report and review of the literature. Oncol Lett 2015; 10:3315-3317. [PMID: 26722332 DOI: 10.3892/ol.2015.3682] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 08/17/2015] [Indexed: 01/08/2023] Open
Abstract
Biliary papillomatosis is a rare benign tumor that possesses a high potential for malignant transformation, and is frequently misdiagnosed. In the present report, a case of biliary papillomatosis with malignant transformation in a 63-year-old female, with a 19-year history of cholelithiasis, is presented. The patient presented with right epigastric pain and magnetic resonance imaging revealed a diffuse mass in the right liver lobe, which extended through the common bile duct. Definitive preoperative diagnosis was unable to be established; however, following surgical resection of the tumor, a diagnosis of biliary papillomatosis with malignant transformation was confirmed by pathological examination. The patient was followed up seven months later and no recurrence was detected. A supplementary review of previously published literature is additionally presented.
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Affiliation(s)
- Chichang Gu
- Second Department of General Surgery, Shunde First People's Hospital Affiliated to Southern Medical University, Foshan, Guangdong 528300, P.R. China ; Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guaugzhou, Guangdong 510080, P.R. China
| | - Y E Lin
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guaugzhou, Guangdong 510080, P.R. China
| | - Haosheng Jin
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guaugzhou, Guangdong 510080, P.R. China
| | - Zhixiang Jian
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guaugzhou, Guangdong 510080, P.R. China
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Joosse ME, Schipper MEI, Libbrecht L, van Buuren HR, de Man RA. Recurrent cholangitis in a 65-year-old man. Biliary papillomatosis. Gut 2015; 64:883, 910. [PMID: 25533647 DOI: 10.1136/gutjnl-2014-308726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/24/2014] [Indexed: 12/08/2022]
Affiliation(s)
- M E Joosse
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
| | - M E I Schipper
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - L Libbrecht
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - H R van Buuren
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
| | - R A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
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16
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Cheong CO, Lim JH, Park JS, Park SW, Kim HK, Kim KS. Volume-reserving Surgery after Photodynamic Therapy for Biliary Papillomatosis: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 66:55-8. [DOI: 10.4166/kjg.2015.66.1.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Chin Ock Cheong
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hong Lim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Seung Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Woo Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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17
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Kuo JY, Jao YTFN. Gallbladder papillomatosis and cholecystocolonic fistula: a rare combination. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:466-70. [PMID: 25351203 PMCID: PMC4224104 DOI: 10.12659/ajcr.891190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Patient: Female, 81 Final Diagnosis: Gallbladder papillomatosis Symptoms: Epigastric pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Jenn-Yuan Kuo
- Department of Gastroenterology, Tainan Municipal Hospital, Tainan, Taiwan
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18
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Singh A, Sharma N, Panda SS, Bajpai M, Jana M. Benign papillomatosis of common bile duct in children: A rare case report. J Indian Assoc Pediatr Surg 2014; 19:44-5. [PMID: 24604985 PMCID: PMC3935301 DOI: 10.4103/0971-9261.125966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In children benign neoplasms are rare events in the extrahepatic biliary ducts and scanty literary references on the subject are available. We are reporting a rare case of a 3-year-old female child having biliary papillomatosis in lower common bile duct.
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Affiliation(s)
- Amit Singh
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Nitin Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shasanka Shekhar Panda
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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19
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Impact of macroscopic morphology, multifocality, and mucin secretion on survival outcome of intraductal papillary neoplasm of the bile duct. J Gastrointest Surg 2013; 17:931-8. [PMID: 23371308 DOI: 10.1007/s11605-013-2151-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 01/16/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intraductal papillary neoplasms of the bile duct (IPNB) are relatively rare disease with favorable prognosis. The authors investigated clinicopathologic characteristics and prognostic factors of IPNB in viewpoint of macroscopic morphology and multiplicity. METHODS Data were collected from 84 patients who underwent surgery at Seoul National University Hospital with diagnosis of IPNB from 2000 to 2009. RESULTS Median follow-up was 41.8 months and 75 (89.3 %) had invasive cancer. Tumors were confined to the bile duct in 45 patients (53.6 %) and 8 (9.5 %) had lymph node metastasis. Curative resection was achieved in 70 patients (89.3 %). Mucin secretion was identified in 23 (28.0 %) and 43 (51.2 %) had multiple tumors. Multiple IPNB had poor prognosis compared with single IPNB (5-year survival rate 50.7 vs. 85.9 %; P = 0.011). Positive resection margin (P = 0.046) and multiplicity (P = 0.038) were independent prognostic factors of IPNB after multivariate analysis. Mucin secretion had no impact on survival outcome (P = 0.595). The disease-free survival rate was significantly lower in multiple IPNB compared with single IPNB (5-year disease free survival rates 36.1 vs. 74.1 %; P = 0.026). CONCLUSION Multiplicity is a common feature of IPNB and has a negative impact on prognosis. Current WHO classification for IPNB needs consideration for macroscopic morphology and multiplicity considering its prognostic impact of IPNB.
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20
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Zhang XF, Qiu FB, He JC, Cao JY, Wang ZS, Han B. A clinical analysis of 11 cases of bile duct adenoma. Shijie Huaren Xiaohua Zazhi 2012; 20:1677-1680. [DOI: 10.11569/wcjd.v20.i18.1677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinicopathologic features, diagnosis and treatment of bile duct adenoma.
METHODS: The clinical data for 11 patients with pathologically confirmed bile duct adenoma at our hospital were retrospectively analyzed.
RESULTS: This group of patients included 9 females and 2 males. Their age ranged from 25 to 75 years, with an average of 62.2 years. Abdominal pain, jaundice and fever were main clinical manifestations. Diagnosis must rely on histopathological examination. Radical resection of the tumor is the most important treatment owing to the high incidence of malignant transformation. Eight patients had papillary adenoma, and 3 had tubule-papillary adenoma. Six cases were associated with cancer, and four cases had varying degrees of dysplasia. One patient underwent biopsy, and 10 patients underwent radical tumor resection. All patients showed no obvious signs of recurrence throughout the follow-up period.
CONCLUSION: Bile duct adenoma has a high incidence of malignant transformation. It is difficult to diagnose before surgery and is easily misdiagnosed. Diagnosis must rely on histopathological examination. Surgical resection is an effective way to treat the disease with a good prognosis.
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22
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Park YM, Rhee K, Yoon SO, Ha JY, Park SY, Lee JH, Jang SI. A Case of Biliary Papillomatosis with Cystic Dilatation of Bile Duct. Yeungnam Univ J Med 2012. [DOI: 10.12701/yujm.2012.29.2.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yoo Mi Park
- Department of Internal Medicine, Gangnam Severance hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kwangwon Rhee
- Department of Internal Medicine, Gangnam Severance hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Och Yoon
- Department of Pathology, Gangnam Severance hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Yoon Ha
- Department of Internal Medicine, Gangnam Severance hospital, Yonsei University College of Medicine, Seoul, Korea
| | - So Young Park
- Department of Internal Medicine, Gangnam Severance hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Ho Lee
- Department of Internal Medicine, Gangnam Severance hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ill Jang
- Department of Internal Medicine, Gangnam Severance hospital, Yonsei University College of Medicine, Seoul, Korea
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23
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Kosemehmetoglu K, Akpinar E, Sokmensuer C, Hamaloglu E. Papillary carcinoma with diffuse papillomatosis of gallbladder and cystic duct. Ann Diagn Pathol 2011; 15:140-4. [DOI: 10.1016/j.anndiagpath.2010.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 02/16/2010] [Indexed: 10/19/2022]
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24
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Affiliation(s)
- Lieve Braeye
- Department of Gastroenterology University Hospital Leuven Belgium.
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25
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Wu SD, Lu CD, Lu CJ, Huang J, Zhou J. Mucin-producing intrahepatic biliary papillomatosis. Surg Today 2010; 40:845-50. [PMID: 20740348 DOI: 10.1007/s00595-009-4132-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 09/11/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Mucin-producing intrahepatic biliary papillomatosis (MPIBP) is an uncommon tumor. The purpose of this study was to evaluate the clinical, radiological, and histopathological characteristics of MPIBP, and its prognosis. METHODS A retrospective analysis was conducted of 11 patients who underwent surgery for MPIBP. The clinical features and radiological, pathological, and operative findings were reviewed, and the survival rates were determined. RESULTS Repeated episodes of fever and epigastric pain with or without jaundice were the common clinical manifestations. Radiologically, all patients showed diffuse bile duct dilatation with cystic change in intrahepatic bile duct. All patients underwent a hepatic resection with or without an extrahepatic bile duct resection. No in-hospital mortality occurred. All patients survived without any signs of recurrence (median 12 +/- 7 months); three patients, including two patients who underwent a palliative resection, had an attack of cholangitis, which was effectively treated with antibiotics. CONCLUSIONS A diagnosis of MPIBP is usually made in patients with biliary dilatation following a radiologic study. Magnetic resonance cholangiopancreatography is more valuable than other modalities in diagnosis. Mucin-producing intrahepatic biliary papillomatosis is a premalignant disease with high malignant potential. The prognosis of MPIBP is excellent if an aggressive resection is performed. A combination of cholangioscopy and frozen sections during the operation is beneficial for a radical successful surgical resection.
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Affiliation(s)
- Sheng-Dong Wu
- Department of General Surgery, Ningbo University School of Medicine, Ningbo 315040, PR China
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26
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Tsuchida K, Yamagata M, Saifuku Y, Ichikawa D, Kanke K, Murohisa T, Tamano M, Iijima M, Nemoto Y, Shimoda W, Komori T, Fukui H, Ichikawa K, Sugaya H, Miyachi K, Fujimori T, Hiraishi H. Successful endoscopic procedures for intraductal papillary neoplasm of the bile duct: A case report. World J Gastroenterol 2010; 16:909-13. [PMID: 20143472 PMCID: PMC2825340 DOI: 10.3748/wjg.v16.i7.909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Attention has recently been focused on biliary papillary tumors as the novel disease entity intraductal papillary neoplasm of the bile duct (IPNB), which consists of papillary proliferation of dysplastic biliary epithelium. As even benign papillary tumors are considered as premalignant, some investigators recommend aggressive surgical therapy for IPNB, although no guidelines are available to manage this disease. Few reports have described long-term follow-up of patients with benign IPNB without radical resection. If patients with IPNB who are treated only with endoscopic procedures are noted, clinical profiles and alternative therapies other than resection may be recommended. We report the case of a patient who experienced repetitive cholangitis for 10 years and was finally diagnosed with IPNB. Radical resection could not be recommended because of the age of the patient, therefore, endoscopic sphincterotomy was performed. Although an endoscopic retrograde biliary drainage catheter was placed several times for repetitive cholangitis, the patient has done well during follow-up. Our case may offer insights into the natural course and management decisions for the novel disease entity of IPNB.
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27
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Jazrawi SF, Nguyen D, Barnett C, Tang SJ. Novel application of intraductal argon plasma coagulation in biliary papillomatosis (with video). Gastrointest Endosc 2009; 69:372-4. [PMID: 18656860 DOI: 10.1016/j.gie.2008.03.1095] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Accepted: 03/25/2008] [Indexed: 12/13/2022]
Affiliation(s)
- Saad F Jazrawi
- Division of Digestive and Liver Diseases, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9151, USA
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28
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Antila KM, Mäkisalo H, Arola J, Numminen K. Best cases from the AFIP: biliary papillomatosis. Radiographics 2009; 28:2059-63. [PMID: 19001658 DOI: 10.1148/rg.287085010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Kristel M Antila
- Department of Surgery, Division of Transplantation and Liver Surgery, Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland.
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Kim JK, Hwang HK, Park JS, Cho SI, Yoon DS, Chi HS. Left hemihepatectomy and caudate lobectomy and complete extrahepatic bile duct resection using transduodenal approach for hilar cholangiocarcinoma arsing from biliary papillomatosis. J Surg Oncol 2008; 98:139-42. [PMID: 18521837 DOI: 10.1002/jso.21089] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Biliary papillomatosis (BP) is a rare disease characterized by multiple papillary lesions of variable distribution and extent in the intra and extrahepatic bile duct. Hepatopancreatoduodenectomy (HPD) can be indicated for the resection of diffuse intra and extrahepatic BP that extended to the distal bile duct and ampullary region. The mortality rate for HPD has recently decreased but HPD still has a high morbidity rate. In this study, we present a safe procedure for concomitant intrahepatic and extrahepatic BP. PATIENTS AND METHODS Preoperative studies showed showed multiple, variable-sized, and nodular papillary masses with mucin in the left intrahepatic ducts, confluence of the right and left hepatic ducts, common hepatic duct, and whole CBD, but peripheral to the right intrahepatic bile ducts were grossly well preserved. We underwent Lt. hepatectomy and the common bile duct and ampulla of Vater were completely resected with transduodenal approach and the pancreatic duct was repositioned to the duodenal mucosa. CONCLUSIONS Major hepatic resection and transduodenal approach for complete bile duct resection and pancreatic duct repositioning could be an acceptable therapeutic option for concomitant intrahepatic and extrahepatic biliary papillomatosis without the evidence of pancreatic duct involvement in the patients with severe comorbidity.
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Affiliation(s)
- Jae Keun Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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31
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Bechmann LP, Hilgard P, Frilling A, Schumacher B, Baba HA, Gerken G, Zoepf T. Successful photodynamic therapy for biliary papillomatosis: A case report. World J Gastroenterol 2008; 14:4234-7. [PMID: 18636672 PMCID: PMC2725388 DOI: 10.3748/wjg.14.4234] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Papillomatosis of the bile duct is a rare disease with a high risk of malignant transformation. Therapeutical options include partial hepatectomy and liver transplantation. A previously healthy 65-years old male developed jaundice and right upper abdominal quadrant pain in 1996. A villous adenoma of the distal bile duct was diagnosed. A Whipple procedure was performed. In 2002 the patient turned symptomatic again. Another adenoma was found in the right hepatic duct resulting in a right hepatectomy. Two years later the patient again developed cholestasis. After drainage of the left hepatic duct with a percutaneous transhepatic cholangial drainage (PTCD) catheter, a recurrent biliary adenomatosis was diagnosed by cholangioscopy. As there was no surgical option left, the patient received photodynamic therapy (PDT) for the recurrent biliary papillomatosis. Three mo after he received further photodynamic therapies, the bile duct epithelium appeared normal and the patient had no signs of adenomatosis, both macroscopically and histologically. The follow-up cholangioscopy in late 2005 revealed only a small papilloma without the need for intervention. In early 2006, the patient died of multi organ failure without signs of extrahepatic cholestasis or cholangitis at the age of 75, 10 years after the diagnosis of biliary papillomatosis was established. The patient exceeded the average life expectancy of patients with biliary papillomatosis by far. Thus, PDT might be a sufficient therapeutic option for recurrent papillomatosis patients with no significant side effects.
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32
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Beguiristain A, Jiménez R, Ruiz-Montesinos I, Echenique Elizondo M. [Diffuse biliary papillomatosis]. Cir Esp 2008; 83:39-40. [PMID: 18208749 DOI: 10.1016/s0009-739x(08)70496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rouzbahman M, Serra S, Adsay NV, Bejarano PA, Nakanuma Y, Chetty R. Oncocytic papillary neoplasms of the biliary tract: a clinicopathological, mucin core and Wnt pathway protein analysis of four cases. Pathology 2007; 39:413-8. [PMID: 17676483 DOI: 10.1080/00313020701444531] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIMS Oncocytic change in papillary neoplasms of the biliary tract is a very uncommon finding with little known about pathogenesis, immunophenotype and prognosis, especially in comparison to similar lesions in the pancreatic ductal system. We report four cases of oncocytic biliary intraductal papillary neoplasms (IPNs), highlighting the clinicopathological characteristics of these tumours, the immunohistochemical profile with regard to Wnt pathway proteins and mucin core protein (MUC) status, and compare these findings with the oncocytic variant of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. METHODS Four cases of oncocytic IPN of the extrapancreatic, biliary tree (two with accompanying invasive carcinomas) were examined for mucin profiles and Wnt signalling proteins. The cases were stained for: beta-catenin, c-myc, glutathione synthase kinase (GSK), E-cadherin, cyclin D1, and adenomatous polyposis coli (APC), and MUC1, MUC2, MUC3, MUC4, MUC5AC, MUC5B and MUC6, using standard immunohistochemistry. RESULTS The cases occurred in three males and one female, ranging in age from 59 to 81 years. The lesions caused obstructive symptoms related to the biliary tree as well as non-specific abdominal symptoms. Typically, cystic lesions were noted grossly. All four of the IPNs were composed of distinctive oncocytic cells. The invasive carcinomas accompanying two of the cases were also composed of oncocytes. None of the cases showed aberrant expression of the Wnt signalling proteins, although cyclin D1 was markedly over-expressed in all four cases. Three of four cases showed the following mucin profile: MUC3, MUC4, MUC5AC, MUC5B and MUC6 positive. CONCLUSIONS The Wnt pathway proteins (especially beta-catenin and E-cadherin) are expressed normally in oncocytic variants of intraductal papillary neoplasms of the biliary tree, and the mucin profile is similar to their counterparts in the pancreas.
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Affiliation(s)
- Marjan Rouzbahman
- Department of Pathology, University Health Network/University of Toronto, Toronto, Canada
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Zalinski S, Paradis V, Valla D, Belghiti J. Intraductal papillary mucinous tumors of both biliary and pancreatic ducts. J Hepatol 2007; 46:978-9. [PMID: 17391800 DOI: 10.1016/j.jhep.2007.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Güllüoglu MG, Ozden I, Poyanli A, Cevikbas U, Ariogul O. Intraductal growth-type mucin-producing peripheral cholangiocarcinoma associated with biliary papillomatosis. Ann Diagn Pathol 2007; 11:34-8. [PMID: 17240305 DOI: 10.1016/j.anndiagpath.2006.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A 64-year-old woman with upper abdominal pain, nausea, and vomiting was admitted. The magnetic resonance imaging revealed marked dilation and "crowding" of the segment 4 bile ducts with an area suspicious for a stone or tumor. Ultrasonography-guided percutaneous transhepatic cholangiography revealed multiple filling defects in the segment 4 bile ducts, the left and common hepatic ducts. A left hepatectomy and cholecystectomy was performed. Dilated bile ducts containing mucinous material and a mass in the cystically dilated bile ducts of segment 4 were detected in the gross examination. It showed continuity within the surrounding dilated bile ducts. The dilated bile ducts of the segments 2 and 3 contained mucinous material without any apparent mass formation. Microscopically, the bile ducts were lined by biliary epithelium displaying simple and complex papillary structures with moderate to severe degree of dysplastic changes. The mass was composed of complex papillary structures filling the bile duct with a few foci of invasion. The papillary structures were composed of mucin-producing columnar cells as well as cells with oncocytic appearance. Patchy cytokeratin 7, cytokeratin 19, hepatocyte paraffin 1, MUC2, and CDX2 immunopositivities were observed. Biliary papillomatosis, mucin-producing intrahepatic cholangiocarcinoma, and intraductal papillary-type peripheral cholangiocarcinoma are in the same disease spectrum of papillary biliary neoplasm and termed as intraductal papillary neoplasm of the liver. Mucinous hypersecretion and signs of mucobilia are considered specific and should raise the suspicion of lesions in this spectrum.
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Affiliation(s)
- Mine G Güllüoglu
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, 34390 Istanbul, Turkey.
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Kim JD, Lee KM, Chung WC, Chang UI, Lee BI, Lee JS, Kim HJ, Yang JM, Choi KY, Chung IS. Acute pancreatitis and cholangitis caused by hemobilia from biliary papillomatosis. Gastrointest Endosc 2007; 65:177-80. [PMID: 17185104 DOI: 10.1016/j.gie.2006.07.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 07/26/2006] [Indexed: 02/08/2023]
Affiliation(s)
- Jin-Dong Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, (Republic of) Korea
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Vassiliou I, Kairi-Vassilatou E, Marinis A, Theodosopoulos T, Arkadopoulos N, Smyrniotis V. Malignant potential of intrahepatic biliary papillomatosis: a case report and review of the literature. World J Surg Oncol 2006; 4:71. [PMID: 17026772 PMCID: PMC1618388 DOI: 10.1186/1477-7819-4-71] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 10/07/2006] [Indexed: 01/24/2023] Open
Abstract
Background Biliary papillomatosis (BP) is a rare disease entity with a strong malignant potential. It is characterized by multiple papillary adenomas involving both the intrahepatic and extrahepatic biliary tree. BP was considered in the past to be a disease with low malignant potential. However, a current review of the English literature revealed a high rate of malignant occurrence of approximately 41% and histological analysis along with the expression pattern of mucin core proteins (MUC) and mucin carbohydrate antigens suggests that BP is a borderline or low grade malignant neoplasm with a high malignant potential. Case presentation A 68 year-old male patient was referred to our hospital due to the presence of sudden right upper quadrant abdominal pain, nausea and dark urine. Imaging workup demonstrated dilatation of the left hepatic duct without the presence of a space-occupying lesion. A left hepatectomy and cholecystectomy were carried out and histological analysis revealed a moderately to poorly differentiated carcinoma of the left hepatic duct in the background of biliary papillomatosis. Postoperative course was uneventful. Unfortunately, two years after initial diagnosis the patient rapidly deteriorated and died from multiple pulmonary secondary deposits. Conclusion BP should not be considered to be a benign disease. The clinical behavior, the high recurrence rate and the even higher malignant transformation occurrence, as well as the presence of carcinogenetic indicators (K-ras mutation, overexpression of p53, MUC and Tn antigens) strongly support that BP is a low-grade neoplasm with high malignant potential.
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Affiliation(s)
- Ioannis Vassiliou
- 2Department of Surgery, Areteion University Hospital, Athens Medical School, Athens, Greece
| | - Evi Kairi-Vassilatou
- Department of Pathology, Areteion University Hospital, Athens Medical School, Athens, Greece
| | - Athanasios Marinis
- 2Department of Surgery, Areteion University Hospital, Athens Medical School, Athens, Greece
| | | | - Nikolaos Arkadopoulos
- 2Department of Surgery, Areteion University Hospital, Athens Medical School, Athens, Greece
| | - Vassilios Smyrniotis
- 2Department of Surgery, Areteion University Hospital, Athens Medical School, Athens, Greece
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Jung AY, Lee JM, Choi SH, Kim SH, Lee JY, Kim SW, Han JK, Choi BI. CT features of an intraductal polypoid mass: Differentiation between hepatocellular carcinoma with bile duct tumor invasion and intraductal papillary cholangiocarcinoma. J Comput Assist Tomogr 2006; 30:173-81. [PMID: 16628028 DOI: 10.1097/00004728-200603000-00002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the CT features capable of differentiating hepatocellular carcinoma (HCC) with bile duct tumor invasion (BDTI) from intraductal cholangiocarcinoma (IDCC). METHODS Multiphasic CT images of 14 patients with HCC with BDTI and 18 patients with IDCC were retrospectively reviewed. Analysis of the CT findings included the size, location, and margin of the intraductal mass, the enhancement pattern of intraductal lesions, degree of ductal dilatation, presence of downstream ductal dilatation and ductal wall thickening, presence of parenchymal mass and its size, continuity of parenchymal mass with intraductal mass, and liver cirrhosis. Objective evaluation of the enhancement patterns of intraductal tumors was done by measuring the CT attenuation coefficients of the tumors and the uninvolved hepatic parenchyma in each phase. Among these findings, statistically significant variables were then determined using Fisher exact test or Mann-Whitney test. RESULTS Significant variables that helped differentiating HCC with BDTI from IDCC included the presence of parenchymal mass, liver cirrhosis, and the hyperattenuating intraductal tumor on the hepatic arterial phase (HAP). On unenhanced images, the tumor-to-liver contrast of IDCC (16.7 +/- 8.1) was greater than that of HCC with BDTI (6.4 +/- 10.4), but on HAP, that of HCC with BDTI (26.5 +/- 28.2) was greater than that of IDCC (5.9 +/- 18.7) (P < 0.05). In addition, there was a significant difference in the enhancement ratio of the intraductal tumors on portal venous phase (PVP) between the 2 conditions (P = 0.003). CONCLUSIONS Several objective and subjective multiphasic CT findings may help differentiating HCC with BDTI from IDCC.
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Affiliation(s)
- Ah Young Jung
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Jung AY, Lee JM, Choi SH, Kim SH, Lee JY, Kim SW, Han JK, Choi BI. Computed tomography features of an intraductal polypoid mass: differentiation between hepatocellular carcinoma with bile duct tumor invasion and intraductal papillary cholangiocarcinoma. J Comput Assist Tomogr 2006; 30:18-24. [PMID: 16365567 DOI: 10.1097/01.rct.0000188837.71136.fe] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the computed tomography (CT) features capable of differentiating hepatocellular carcinoma (HCC) with bile duct tumor invasion (BDTI) from intraductal cholangiocarcinoma (IDCC). METHODS Multiphasic CT images of 14 patients with HCC with BDTI and 18 patients with IDCC were retrospectively reviewed. Analysis of the CT findings included the size, location, and margin of the intraductal mass; enhancement pattern of intraductal lesions; degree of ductal dilatation; presence of downstream ductal dilatation and ductal wall thickening; presence of a parenchymal mass and its size; continuity of the parenchymal mass with the intraductal mass; and liver cirrhosis. Objective evaluation of the enhancement patterns of intraductal tumors was done by measuring the CT attenuation coefficients of the tumors and the uninvolved hepatic parenchyma in each phase. Among these findings, statistically significant variables were then determined using the Fisher's exact test or Mann-Whitney U test. RESULTS Significant variables that helped to differentiate HCC with BDTI from IDCC included the presence of a parenchymal mass, liver cirrhosis, and a hyperattenuating intraductal tumor on the hepatic arterial phase (HAP). On unenhanced images, the tumor-to-liver contrast of IDCC (16.7+/-8.1) was greater than that of HCC with BDTI (6.4+/-10.4), but on the HAP, that of HCC with BDTI (26.5+/-28.2) was greater than that of IDCC (5.9+/-18.7) (P<0.05). In addition, there was a significant difference in the enhancement ratio of the intraductal tumors on the portal venous phase between the 2 conditions (P=0.003). CONCLUSIONS Several objective and subjective multiphasic CT findings may help to differentiate HCC with BDTI from IDCC.
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Affiliation(s)
- Ah Young Jung
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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