scholarly journals A case of hepatic intraductal papillary neoplasm of the bile duct

2021 ◽  
Author(s):  
Eisuke Mukaida ◽  
Akio Tamura ◽  
Kunihiro Yoshioka ◽  
Masao Nishiya ◽  
Tamotsu Sugai
Keyword(s):  
Magnetic Resonance Imaging ◽  
Bile Duct ◽  
Invasive Carcinoma ◽  
Pathological Findings ◽  
Resonance Imaging ◽  
Intraductal Papillary Neoplasm ◽  
History Of ◽  
Right Lobe ◽  
The Right ◽  
Papillary Neoplasm

In this report, we present a 57-year-old female with a history of mild alcoholic liver disease during a medical check-up. Abdominal computed tomography and magnetic resonance imaging showed a multicystic mass with a solid enhancing mural nodule in the right lobe of the liver. Subsequently, laparoscopic right liver lobectomy was performed and pathological findings revealed intraductal papillary neoplasm of the bile duct (IPNB) with an associated invasive carcinoma. IPNB is a relatively rare disease that should be considered in the differential diagnosis of hepatic cystic tumours. Our case report highlights the importance of capturing image findings of the IPNB as this disease has a high potential for malignancy.

Diagnostic role of ASL-perfusion of liver in magnetic resonance imaging in assessing risk of developing portal hypertension in patients with viral hepatitis

2021 ◽  
pp. 38-43
Author(s):  
E. N. Simakina ◽  
T. G. Morozova
Keyword(s):  
Magnetic Resonance Imaging ◽  
Portal Hypertension ◽  
Magnetic Resonance ◽  
Viral Hepatitis ◽  
Prognostic Significance ◽  
Resonance Imaging ◽  
Diagnostic Role ◽  
Right Lobe ◽  
The Right

Objective. To establish the diagnostic role of ASL-perfusion of the liver in magnetic resonance imaging (MRI) in assessing the risk of portal hypertension in patients with viral hepatitis. Materials and methods. 109 patients with viral hepatitis were examined, including 69 (63.3 %) men and 40 (36.7 %) women, the average age of patients was 49.0 ± 2.3 years. All subjects (n = 109) underwent abdominal ultrasound with doppler vascular examination and clinical elastography, ASL-perfusion of the liver with MRI with an assessment of the volume of hepatic blood flow (HBF, ml/100 g/min).Results. The highest diagnostic and prognostic significance of ASL-perfusion for the liver is a targeted study of changes in the right lobe: for the right lobe, AUROC = 0.886 (95 % CI: 0.799–0.889); for the left, AUROC = 0.635 (95 % CI 0.627–0.641). The diagnostic and prognostic significance of ASLperfusion was evaluated in comparison with ultrasound with doppler vascular examination: AUROC = 0.991 (95 % CI: 0.880–0.993); AUROC = 0.801 (95 % CI: 0.776–0.804), respectively. The quantitative and qualitative characteristics of ASL – liver perfusion were evaluated.Conclusion. When performing ASL-perfusion of the liver, MRI should evaluate quantitative and qualitative criteria. Criteria for the prognosis of portal hypertension according to ASL- perfusion in MRI in patients with viral hepatitis: HBF 131–160 ml/100 g /min, red card – very high risk, HBF = 161–185 ml/100 g/min, red card – high, HBF = 40–130 ml/100 g/min, mixed card – medium; HBF = 131–160 ml/100 g/min, blue card-low risk (r = 0.883).

Progressive Spasticity With a Single Magnetic Resonance Imaging Lesion

2021 ◽  
pp. 20-21
Author(s):  
Samantha A. Banks ◽  
Eoin P. Flanagan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Magnetic Resonance ◽  
Oligoclonal Bands ◽  
Resonance Imaging ◽  
Fluid Analysis ◽  
Skin Cancers ◽  
Clinical Episode ◽  
History Of ◽  
The Right

A 59-year-old White man with a history of excised basal and squamous cell skin cancers was evaluated for gait difficulties. He had erectile dysfunction but no bowel or bladder dysfunction. He also reported fatigue. He began using a cane for ambulation 2 weeks before evaluation at our facility. His medications included vitamin D and sildenafil. He was a lifelong nonsmoker and had no family history of multiple sclerosis. Neurologic examination at the time of our evaluation 3 years after onset was notable for a positive Hoffman sign on the right and mild weakness of the right triceps but preserved strength elsewhere. He had a spastic gait with moderate spasticity in both lower extremities, hyperreflexic patellar and ankle jerks bilaterally, and bilateral positive Babinski sign. The remainder of the examination was essentially normal. Magnetic resonance imaging of the brain showed a single lesion at the cervicomedullary junction and medullary pyramids, more prominent on the right. There was also some accompanying atrophy that was also visible on cervical spine magnetic resonance imaging. Results of cerebrospinal fluid analysis showed a normal white blood cell count, increased protein concentration (108 mg/dL), and positive oligoclonal bands. The progressive nature of his symptoms, spinal fluid results, and lesion appearance were all consistent with a diagnosis of progressive solitary sclerosis. At the time this patient was seen, no immunomodulatory medications for progressive solitary sclerosis were approved, so no immunomodulatory medication was tried. Ongoing symptomatic management was recommended. Progressive solitary sclerosis is a rare variant of multiple sclerosis in which patients have a single central nervous system demyelinating lesion and development of motor progression attributable to that lesion. Patients can initially have a clinical episode followed by progression or can have a progressive course without an initial relapse.

Intraductal papillary neoplasm of bile duct: all rare in one

2020 ◽  
Vol 13 (11) ◽  
pp. e237001
Author(s):  
Aprajita Chaturvedi ◽  
Manjunath Maruti Pol ◽  
Kirti Jangra ◽  
Priyanka Singh
Keyword(s):  
Bile Duct ◽  
Histopathological Examination ◽  
Anatomical Variations ◽  
Small Lesion ◽  
Low Grade ◽  
Pathological Findings ◽  
Intraductal Papillary Neoplasm ◽  
Contrast Enhanced ◽  
Low Grade Dysplasia ◽  
Papillary Neoplasm

A 45-year-old woman was referred from Department of Dermatology to Surgery outpatient department with pruritus since 6 months and an episode of jaundice that lasted for 15 days about 6 months ago. She was referred with a contrast-enhanced MRI finding that showed a small lesion in the lower end of common bile duct. Endoscopy-guided biopsy was performed twice at our hospital, the second revealed low grade dysplasia. Consequently, she underwent pancreaticoduodenectomy. Intraoperatively, there were both vascular and biliary anatomical variations that were missed on preoperative images. On histopathological examination, it turned out to be a mixed variety of intraductal papillary neoplasm of bile duct (IPNB). As all findings were rare in one, hence, we present this case of IPNB that presented to us with variable clinical, radiological, surgical and pathological findings.

scholarly journals Intraductal Papillary Neoplasm of the Bile Duct With Invasive Adenocarcinoma Complicating IgG4-related Sclerosing Cholangitis: Report of a Case

2017 ◽  
Vol 102 (1-2) ◽  
pp. 70-76
Author(s):  
Ryo Ashida ◽  
Teiichi Sugiura ◽  
Yukiyasu Okamura ◽  
Takaaki Ito ◽  
Keiko Sasaki ◽  
...  
Keyword(s):  
Bile Duct ◽  
Sclerosing Cholangitis ◽  
Invasive Carcinoma ◽  
Extrahepatic Bile Duct ◽  
Inflammatory Cells ◽  
Wall Thickening ◽  
Multidetector Row Computed Tomography ◽  
Intraductal Papillary Neoplasm ◽  
Serum Igg4 ◽  
Papillary Neoplasm

Although there have been many previous studies of IgG4-related SC focusing on the differential diagnosis from cholangiocarcinoma, only a few patients with cholangiocarcinoma against a background of IgG4-related SC have been reported. We herein present a case of intraductal papillary neoplasm of the bile duct (IPNB) associated with invasive carcinoma complicating IgG4-related sclerosing cholangitis. A 71-year-old female with icterus was admitted to a local hospital, where stricture of the extrahepatic bile duct were detected, and subsequently referred to our hospital for possible surgery. Abdominal multidetector-row computed tomography demonstrated marked wall thickening along the entire extrahepatic bile duct. The left lateral superior bile duct (B2) and left lateral inferior duct (B3) were individually obstructed, and percutaneous transhepatic biliary drainage catheters were placed in B2 and B3 separately. The patient was diagnosed to have diffusely spread cholangiocarcinoma and underwent right hepatic trisectionectomy with caudate lobectomy and pancreatoduodenectomy. A histological examination revealed intraductal papillary tumors composed of fibrovascular stalks covered by neoplastic epithelium. Carcinomatous invasion of the papillary tumors was observed in the fibromuscular layer, and there was abundant infiltration of inflammatory cells with fibrosis outside of the cancerous tissue. The inflammatory cells were primarily composed of plasma cells, a majority of which were positive for IgG4 (>30 cells/high-power field); the postoperative serum IgG4 level was 890 mg/dL. Therefore, a diagnosis of coexisting IPNB associated with invasive carcinoma and IgG4-related sclerosing cholangitis was made. To the best of our knowledge, this is the first report of IPNB complicating IgG4-related sclerosing cholangitis.

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.

Surgical treatment of a cerebral brain abscess in a cat

2011 ◽  
Vol 24 (01) ◽  
pp. 72-75 ◽  
Author(s):  
M. Beukers ◽  
L. F. H. Theyse ◽  
E. G. H. Wouters
Keyword(s):  
Magnetic Resonance Imaging ◽  
Histopathological Examination ◽  
Resonance Imaging ◽  
Ataxic Gait ◽  
Pupillary Light ◽  
Small Defect ◽  
History Of ◽  
The Right ◽  
Extensive Necrosis ◽  
Temporal Lobe Lesion

SummaryA nine-year-old male castrated European Shorthair cat was presented with a six-day history of progressive depression and ataxic gait. Neurological examination revealed depression, absent menace in the left eye, absent pupillary light reflex in the right eye, anisocoria, circling to the right, and delayed proprioception in all limbs. Magnetic resonance imaging showed a space-occupying right temporal lobe lesion adjacent to a small defect in the temporal bone suggestive of a meningo-encephalitis with concurrent abscess formation. The site was surgically approached by a rostrotentorial craniectomy. A cerebral abscess was found and debrided. Histopathological examination of the removed tissue demonstrated a subacute to chronic purulent encephalitis with extensive necrosis of brain tissue. Neurological symptoms resolved completely within two weeks and full recovery was observed four weeks after surgery.

Intrahepatic Carcinosarcoma With Cholangiocarcinoma Elements and Prominent Bile Duct Spread

2019 ◽  
Vol 27 (8) ◽  
pp. 900-906
Author(s):  
Genki Usui ◽  
Hirotsugu Hashimoto ◽  
Masashi Kusakabe ◽  
Go Shirota ◽  
Yoshiya Sugiura ◽  
...  
Keyword(s):  
Bile Duct ◽  
Intrahepatic Bile Duct ◽  
High Signal ◽  
Radiological Findings ◽  
Tumor Spread ◽  
Intraductal Papillary Neoplasm ◽  
The Right ◽  
Glutamyl Transferase ◽  
Papillary Neoplasm ◽  
And Diffusion

Carcinosarcomas with elements of cholangiocarcinoma and sarcoma are rare and have a poor prognosis. The spreading pattern and radiological findings of these lesions remain unclear. A 74-year-old man presented with a high γ-glutamyl transferase level. Magnetic resonance imaging revealed dilation of the right intrahepatic and common bile ducts, consistent with an intraductal papillary neoplasm of the bile duct (IPNB), and diffusion-weighted imaging (DWI) indicated an area of high signal intensity in the intrahepatic bile duct. Bile duct biopsy yielded a small amount of atypical spindle cells, and the patient underwent a right hepatectomy. Microscopically, the tumor contained cholangiocarcinoma and sarcomatous components, including osteosarcoma and leiomyosarcoma, leading to a diagnosis of intrahepatic carcinosarcoma. The tumor spread primarily through the intrahepatic bile duct. An accurate radiological diagnosis of carcinosarcoma was challenging, given the apparent similarities with IPNB. The findings from DWI and pathology of a bile duct biopsy may assist with preoperative diagnosis.

Intraductal papillary neoplasm of bile duct with invasive carcinoma as an intrahepatic cystic lesion, with successful preoperative diagnosis

2022 ◽  
Vol 15 (1) ◽  
pp. e245918
Author(s):  
Tetsuro Takasaki ◽  
Takashi Sakamoto ◽  
Akira Saito ◽  
Yasuaki Motomura
Keyword(s):  
Bile Duct ◽  
Cystic Lesion ◽  
Invasive Carcinoma ◽  
Pathological Examination ◽  
Mucus Production ◽  
Intraductal Papillary Neoplasm ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Elevated Liver Enzymes ◽  
Papillary Neoplasm

An 82-year-old man presented to the emergency department with abdominal pain and febrile symptoms that had been present for 4 days. Blood tests showed elevated liver enzymes and white blood cell count, and abdominal contrast-enhanced CT revealed a 35 mm cystic lesion in the left lateral liver lobe. On closer examination, the cystic lesion was found to have contiguous bile duct dilatation and internal nodules. Furthermore, mucus production was observed during endoscopic retrograde cholangiopancreatography, which led to the diagnosis of intraductal papillary neoplasm of the bile duct (IPNB), with cystic infection. Although the patient was an older adult, there was no background disease that would have prevented surgery, and resection was performed. Pathological examination revealed type 1 IPNB, with invasive carcinoma. The number of reports of IPNB is expected to increase with an increasing older population in Asia, and we report the findings of this case.

scholarly journals Ptotic Gall Bladder with Hepatic Masses: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Hasan Aydin ◽  
Z. Banu Aydin ◽  
Baki Hekimoğlu ◽  
Ayşe Görmeli
Keyword(s):  
Magnetic Resonance Imaging ◽  
Gall Bladder ◽  
Left Lobe ◽  
Resonance Imaging ◽  
Abdominal Ultrasonography ◽  
Inferior Pole ◽  
Right Lobe ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Lying Down

Gall bladder (GB) may be found in a variety of abnormal positions. Most of them are due to arrested development of embryonic growth at different stages. A 63-year-old female patient was admitted to our radiology unit for magnetic resonance imaging (MRI) of the liver for the lesions identified in abdominal ultrasonography (US) and computed tomography (CT). MRI showed that there was a lobulated heterogenous mass in the left lobe of the liver and a smaller one in the right lobe of the liver with the same appearance. The inferior pole of the liver was located in the pelvic space, and the GB, which contained sludges and stones, was lying down to the upper pelvic space. Hepatic masses were considered to be hemangiomas, and GB was diagnosed as ptotic GB with luminal sludge and stones. In this case, especially, MR imaging helped the surgeon to plan a proper approach to the GB in abnormal localization.

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