Case Report
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World J Gastroenterol. Apr 14, 2011; 17(14): 1923-1926
Published online Apr 14, 2011. doi: 10.3748/wjg.v17.i14.1923
Intraductal papillary neoplasm of the bile duct in liver cirrhosis with hepatocellular carcinoma
Jing Xu, Yasunori Sato, Kenichi Harada, NorihideYoneda, Teruyuki Ueda, Atsushi Kawashima, AkishiOoi, YasuniNakanuma
Jing Xu, Yasunori Sato, Kenichi Harada, NorihideYoneda, YasuniNakanuma, Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan
Jing Xu, Department of Pathology, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Teruyuki Ueda, Internal Medicine for Digestive Organs, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan
Atsushi Kawashima, AkishiOoi, Department of Molecular Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan
Author contributions: Xu J and Sato Y contributed equally to this work; Harada K and Yoneda N performed the immunohistochemical analysis; Ueda T, Kawashima A, and Ooi A cared for the patient and performed the autopsy; Nakanuma Y wrote the paper.
Correspondence to: YasuniNakanuma, MD, Department of Human Pathology, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa 920-8640, Japan. pbcpsc@kenroku.kanazawa-u.ac.jp
Telephone: +81-76-2652197 Fax: +81-76-2344229
Received: August 11, 2010
Revised: December 16, 2010
Accepted: December 23, 2010
Published online: April 14, 2011
Abstract

A case of intraductal papillary neoplasm of the bile duct (IPNB) arising in a patient with hepatitis B-related liver cirrhosis with hepatocellular carcinoma (HCC) is reported. A 76-year-old man was admitted to our hospital with recurrent HCC. Laboratory data showed that levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated. He died of progressive hepatic failure. At autopsy, in addition to HCCs, an intraductal papillary proliferation of malignant cholangiocytes with fibrovascular cores was found in the dilated large bile ducts in the left lobe, and this papillary carcinoma was associated with an invasive mucinous carcinoma (invasive IPNB). Interestingly, extensive intraductal spread of the cholangiocarcinoma was found from the reactive bile ductular level to the interlobular bile ducts and septal bile ducts and to the large bile ducts in the left lobe. Neural cell adhesion molecule, a hepatic progenitor cell marker, was detected in IPNB cells. It seems possible in this case that hepatic progenitor cells located in reactive bile ductules in liver cirrhosis may have been responsible for the development of the cholangiocarcinoma and HCC, and that the former could have spread in the intrahepatic bile ducts and eventually formed grossly visible IPNB.

Keywords: Papillary carcinoma; Bile duct neoplasms; Liver cirrhosis; Progenitor cells; Hepatocellular carcinoma; Neural cell adhesion molecules