scholarly journals Intracholecystic papillary neoplasm arising in a patient with pancreaticobiliary maljunction: a case report

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Toshimitsu Iwasaki ◽  
Yasuhiro Otsuka ◽  
Yoichi Miyata ◽  
Takahiro Einama ◽  
Hironori Tsujimoto ◽  
...  
Keyword(s):  
Bile Duct ◽  
Pancreatic Duct ◽  
Biliary Tract ◽  
Pancreaticobiliary Maljunction ◽  
Resected Specimen ◽  
Duodenal Wall ◽  
Biliary Cancer ◽  
Pancreatobiliary Reflux ◽  
Gastric Type ◽  
Papillary Neoplasm

Abstract Background Pancreaticobiliary maljunction (PBM) is a congenital abnormality in which the pancreatic and biliary ducts join anatomically outside the duodenal wall resulting in the regurgitation of pancreatic juice into the biliary tract (pancreatobiliary reflux). Persistent pancreatobiliary reflux causes injury to the epithelium of the biliary tract and promotes the risk of biliary cancer. Intracholecyctic papillary neoplasm (ICPN) has been highlighted in the context of a cholecystic counterpart of intraductal papillary mucinous neoplasm of the pancreas and the bile duct, but the tumorigenesis of ICPNs remains unclear. Case presentation A 52-year-old Japanese woman was referred for the assessment of dilation of the bile duct. Computed tomography which revealed an enhanced mass in the gallbladder and endoscopic retrograde cholangiopancreatography confirmed that the confluence of the main pancreatic duct and extrahepatic bile duct (EHBD) was located outside the duodenal wall. Under the diagnosis of gallbladder cancer with PBM, cholecystectomy with full thickness dissection, EHBD resection, lymph node dissection, and hepaticojejunostomy were performed. Macroscopic examination of the resected specimen showed that the cystic duct was dilated and joined into the EHBD just above its confluence with the pancreatic duct, and the inflamed change of non-tumorous mucosa of gallbladder indicating that there was considerable mucosal injury due to pancreatobiliary reflux to the gallbladder. Histopathological examination revealed that the gallbladder tumor was a gastric-type ICPN with non-invasive component. Either KRAS gene mutation or p53 protein expression that were known to be associated with the carcinogenesis of biliary cancer under the condition of pancreatobiliary reflux was not detected in the tumor cells of ICPN. Conclusion The present case might suggest that there was no association between PBM and ICPN. To reveal the tumorigenesis of ICPN and its attribution to pancreatobiliary reflux, however, further study is warranted.

scholarly journals Intracholecystic papillary neoplasm arising in a patient with pancreaticobiliary maljunction: A case report

2020 ◽  
Author(s):  
Toshimitsu Iwasaki ◽  
Yasuhiro Otsuka ◽  
Yoichi Miyata ◽  
Takahiro Einama ◽  
Hironori Tsujimoto ◽  
...  
Keyword(s):  
Bile Duct ◽  
Pancreatic Duct ◽  
Biliary Tract ◽  
Pancreaticobiliary Maljunction ◽  
Resected Specimen ◽  
Duodenal Wall ◽  
Biliary Cancer ◽  
Pancreatobiliary Reflux ◽  
Gastric Type ◽  
Papillary Neoplasm

Abstract Background: Pancreaticobiliary maljunction (PBM) is a congenital abnormality in which the pancreatic and biliary ducts join anatomically outside the duodenal wall resulting in the regurgitation of pancreatic juice into the biliary tract (pancreatobiliary reflux). Persistent pancreatobiliary reflux causes injury to the epithelium of the biliary tract and promotes the risk of biliary cancer. Intracholecyctic papillary neoplasm (ICPN) has been highlighted in the context of a cholecystic counterpart of intraductal papillary mucinous neoplasm of the pancreas and the bile duct, but the tumorigenesis of ICPNs remains unclear. Case presentation: A 52-year-old Japanese woman was referred for the assessment of dilation of the bile duct. Computed tomography revealed an enhanced mass in the gallbladder and endoscopic retrograde cholangiopancreatography confirmed that the confluence of main pancreatic duct and extrahepatic bile duct (EHBD) was located outside the duodenal wall. Under the diagnosis of gallbladder cancer with PBM, cholecystectomy with full thickness dissection, EHBD resection, lymph node dissection, and hepaticojejunostomy were performed. Macroscopic examination of the resected specimen showed that the cystic duct was dilated and joined into the EHBD just above its confluence with the pancreatic duct, and the inflamed change of noncancerous mucosa of gallbladder indicating that there was considerable mucosal injury due to pancreatobiliary reflux to the gallbladder. Histopathological examination revealed that the gallbladder tumor was a gastric-type ICPN with non-invasive component. Either KRAS gene mutation or p53 protein expression that were known to be associated with the carcinogenesis of biliary cancer under the condition of pancreatobiliary reflux was not detected in the tumor cells of ICPN. Conclusion: The present case might suggest that there was no association between PBM and ICPN. To reveal the tumorigenesis of ICPN and its attribution to pancreatobiliary reflux, however, further study is warranted.

scholarly journals Intracholecystic Papillary Neoplasm Arising in A Patient with Pancreaticobiliary Maljunction: A Case Report

2020 ◽  
Author(s):  
Toshimitsu Iwasaki ◽  
Yasuhiro Otsuka ◽  
Yoichi Miyata ◽  
Takahiro Einama ◽  
Hironori Tsujimoto ◽  
...  
Keyword(s):  
Bile Duct ◽  
Protein Expression ◽  
Pancreatic Duct ◽  
P53 Protein ◽  
Pancreaticobiliary Maljunction ◽  
Duodenal Wall ◽  
Biliary Cancer ◽  
P53 Protein Expression ◽  
Pancreatobiliary Reflux ◽  
Papillary Neoplasm

Abstract Background: Pancreaticobiliary maljunction (PBM) is a congenital abnormality in which the pancreatic and biliary ducts join anatomically outside the duodenal wall resulting in the regurgitation of pancreatic juice into the biliary tract (pancreatobiliary reflux). Persistent pancreatobiliary reflux causes injury to the epithelium of the biliary tract and promotes the risk of biliary cancer. Intracholecyctic papillary neoplasm (ICPN) has been highlighted in the context of a cholecystic counterpart of intraductal papillary mucinous neoplasm of the pancreas and the bile duct, but the tumoriogenesis of ICPNs remains unclearCase presentation: A 52-year-old Japanese woman was referred for the assessment of dilation of the bile duct. Computed tomography revealed an enhanced mass in the gallbladder and endoscopic retrograde cholangiopancreatography confirmed that the confluence of main pancreatic duct and extrahepatic bile duct (EHBD) was located outside the duodenal wall. Under the diagnosis of gallbladder cancer with PBM, cholecystectomy with full thickness dissection, EHBD resection, lymph node dissection, and hepaticojejunostomy were performed. Macroscopic examination of the resected specimen showed that the cystic duct was dilated and joined into the EHBD just above its confluence with the pancreatic duct, and the inflamed change of noncancerous mucosa of gallbladder indicating that there was considerable mucosal injury due to pancreatobiliary reflux to the gallbladder. Histopathological examination revealed that the gallbladder tumor was a gastric-type ICPN with non-invasive component. Either KRAS gene mutation or p53 protein expression that were known to be associated with the carcinogenesis of biliary cancer under the condition of pancreatobiliary reflux was not detected in the tumor cells of ICPN.Conclusion: The analyses of KRAS gene mutation and p53 protein expression were helpful to elucidate the tumorigenesis of ICPN and indicated there was no apparent association between ICPN and PBM.

scholarly journals Lung metastases from intraductal papillary neoplasm of the bile duct: a case report

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Rika Fujino ◽  
Yoshihito Masuoka ◽  
Taro Mashiko ◽  
Akira Nakano ◽  
Kenichi Hirabayashi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bile Duct ◽  
Lung Metastases ◽  
Tumor Resection ◽  
World Health ◽  
Resected Specimen ◽  
Pathological Findings ◽  
Liver Recurrence ◽  
Intraductal Papillary Neoplasm ◽  
Papillary Neoplasm

Abstract Background Intraductal papillary neoplasm of the bile duct (IPNB) is considered a pre-cancerous biliary lesion and/or an early cancer lesion, although its classification remains unclear. The 2019 revised edition of the World Health Organization Classification of Tumors of the Digestive System proposed type 1 and type 2 as new classification categories, and meta-analyses and/or multi-center cohort studies are beginning to be reported. However, treatment for IPNB recurrence and metastasis remains unclear. Case presentation A 60-year-old man who was referred to our hospital after a suspected liver tumor was diagnosed using abdominal ultrasonography. Imaging findings revealed an irregularly shaped tumor in segment 5 (S5) of the liver (size 20 mm). The S5 lesion was suspected as IPNB, and segmentectomy was performed. The pathological findings revealed invasive carcinoma derived from IPNB, and immunohistochemistry revealed positive expression of MUC1, MUC5AC, and MUC6, but negative expression of CDX2 and MUC2. At 9 months after the surgery, computed tomography revealed a tumor in the right bile duct, which was diagnosed as liver recurrence of IPNB, and right hepatectomy was performed. The histopathological findings were the same as for the first resected specimen (i.e., IPNB). At 45 months after the second surgery, computed tomography revealed nodules in both lungs, which were diagnosed as lung metastases from IPNB and resected in two separate procedures. The pathological findings were metastatic carcinoma from IPNB for both lung lesions. The patient is currently alive and undergoing adjuvant chemotherapy (S-1), which was initiated 64 months after the first resection and 12 months after resection of the lung metastases. Conclusion We encountered a rare case of lung metastases from IPNB, which were diagnosed immunohistologically. Because IPNB is generally a slow-growing tumor, resection may be feasible for IPNB recurrence and/or metastasis, which may be detected during long-term follow-up. Thus, even if resection is performed for primary IPNB, additional surgical treatment may be feasible in this setting.

Some problems of diagnosing a disease of the hepatopancreatobilpar zone

1993 ◽  
Vol 74 (3) ◽  
pp. 228-230
Author(s):  
I. I. Kamalov
Keyword(s):  
Gastrointestinal Tract ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Pancreatic Duct ◽  
Biliary Tract ◽  
Acalculous Cholecystitis ◽  
Primary Driver ◽  
The Common ◽  
Calculous Cholecystitis

Changes of an inflammatory, tumor nature in the biliary tract are primarily associated with various disorders of the gastrointestinal tract. Cholecystitis is usually accompanied by duodenal dyskinesia. With acalculous cholecystitis (32 obs.), Hypomotor dyskinesia occurs, with calculous cholecystitis (68 obs.), Hypermotor dyskinesia of the duodenum. Various forms of cholecystitis (calculous, bacterial, parasitic, enzymatic) and, less often, pancreatitis develops secondarily. The primary driver of their development is impaired motility of the duodenum. In the pancreatic duct, the pressure is 98 Pa higher than in the common bile duct, -981 Pa.

scholarly journals Multiple Cancers of the Biliary Tract and Pancreatic Duct after Cholecystectomy for Gallbladder Cancer in a Patient with Pancreaticobiliary Maljunction

2016 ◽  
Vol 55 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Kazuya Koizumi ◽  
Junpei Sasajima ◽  
Toru Kawamoto ◽  
Yoshiaki Sugiyama ◽  
Mizue Muto ◽  
...  
Keyword(s):  
Gallbladder Cancer ◽  
Pancreatic Duct ◽  
Biliary Tract ◽  
Pancreaticobiliary Maljunction ◽  
Multiple Cancers

scholarly journals Intraductal Dissemination of Bile Duct Carcinoma with Pancreaticobiliary Maljunction in the Pancreatic Duct after Pancreatoduodenectomy

2017 ◽  
Vol 50 (5) ◽  
pp. 393-400
Author(s):  
Yuki Higashi ◽  
Koichi Shimizu ◽  
Toshifumi Watanabe ◽  
Shiro Terai ◽  
Youhei Kawahara ◽  
...  
Keyword(s):  
Bile Duct ◽  
Pancreatic Duct ◽  
Bile Duct Carcinoma ◽  
Pancreaticobiliary Maljunction ◽  
Duct Carcinoma

scholarly journals Observational Study of Variations in Termination of the Common Bile Duct in Human Cadaver

2015 ◽  
Vol 12 (1) ◽  
pp. 11-13
Author(s):  
Laila Farzana Khan ◽  
Humaira Naushaba ◽  
Jubaida Gulshan Ara
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Distal Portion ◽  
Duodenal Wall ◽  
Common Channel ◽  
Cross Sectional ◽  
Medical College ◽  
The Common

Context: The union of the distal portion of the common bile duct and the main pancreatic duct varies. They together may form short common channel or long common channel or may open separately into the second part of the duodenum. So detailed anatomical knowledge is essential for any surgical or endoscopic treatment of this region. Materials and Methods: A cross sectional descriptive type of study was carried out in the department of Anatomy, Sir Salimullah Medical College on sixty two (62) human cadaveric extra hepatic biliary apparatus with pancreatic duct. The samples were collected from unclaimed dead bodies that were under examination in the department of Forensic Medicine of Dhaka Medical College, Dhaka and Sir Salimullah Medical College, Dhaka. The present study was conducted to observe the variations in termination of common bile duct with main pancreatic duct in human cadavers. Results: The common bile duct was found to unite with main pancreatic duct within the duodenal wall in 61.3% cases and outside the duodenal wall in 38.7% cases. Conclusion: The findings of the present study revealed that the termination of the common bile duct varies from individual to individual. DOI: http://dx.doi.org/10.3329/bja.v12i1.22611 Bangladesh Journal of Anatomy, January 2014, Vol. 12 No. 1 pp 11-13

scholarly journals Recurrent intraductal papillary neoplasm of the bile duct due to intraductal dissemination: a case report and literature review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuki Nakayama ◽  
Takahiro Tomino ◽  
Mizuki Ninomiya ◽  
Ryosuke Minagawa ◽  
Yumi Oshiro ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Curative Resection ◽  
Hepatic Duct ◽  
Intraductal Papillary Neoplasm ◽  
Gastric Type ◽  
Papillary Structure ◽  
The Common ◽  
Papillary Neoplasm ◽  
Papillary Growth

Abstract Background Intraductal papillary neoplasm of the bile duct (IPNB) is a subtype of biliary tumor. The 5-year survival rate of patients with IPNB who underwent curative resection is 81%. However, IPNB is known to often recur in other parts of the bile duct. Nevertheless, its mechanism remains poorly understood. Herein, we report the case of a patient with recurrent IPNB, which was considered to be attributed to intraductal dissemination in the common bile duct at 12 months after curative resection. We also made a review of the existing literature. Case presentation A 69-year-old man was referred to our hospital for the evaluation and dilation of an intrahepatic bile duct (IHBD) mass. Computed tomography (CT) findings confirmed a mass in the left hepatic duct. Left trisectionectomy, extrahepatic bile duct resection with biliary reconstruction, and regional lymph node dissection were performed. Intraoperative examination of the resection margin at the common bile duct and posterior segmental branch of the hepatic duct was negative for the presence of malignant cells. Histologically, the tumor showed intraductal papillary growth of the mucinous epithelium and was diagnosed as non-invasive IPNB. It had a papillary structure with atypical epithelial cells lined up along the neoplastic fibrovascular stalks. Immunohistochemically, this was as a gastric-type lesion. At 12 postoperative months, CT revealed a 1.5-cm mass in the lower remnant common bile duct. We performed subtotal stomach-preserving pancreaticoduodenectomy. The tumor exhibited papillary growth and was microscopically and immunohistochemically similar to the first tumor. At approximately 16 months after the patient’s second discharge, CT showed an abdominal mass at the superior mesenteric plexus, which was diagnosed as recurrent IPNB. Chemotherapy is ongoing, and the patient is still alive. In this case, as described in many previous reports, IPNB recurred below the primary lesion in the bile duct. Conclusion Based on our review of previous reports on IPNB recurrence, intraductal dissemination was considered one of the mechanisms underlying recurrence after multicentric development. Considering the high frequency and oncological conversion of recurrence in IPNB, regular follow-up examination is essential to achieve better prognosis in patients with recurrent IPNB.

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