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

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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Intraductal papillary neoplasm of the left hepatic duct treated with endoscopic retrograde cholangiopancreatography guided radiofrequency ablation

Clinical Journal of Gastroenterology ◽

10.1007/s12328-020-01284-4 ◽

2020 ◽

Author(s):

Steven Delaney ◽

Yi Zhou ◽

Swati Pawa ◽

Rishi Pawa

Keyword(s):

Radiofrequency Ablation ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Hepatic Duct ◽

Endoscopic Retrograde ◽

Left Hepatic Duct ◽

Intraductal Papillary Neoplasm ◽

Papillary Neoplasm

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S1600 Intraductal Papillary Neoplasm of the Left Hepatic Duct Treated With Endoscopic Retrograde Cholangiopancreatography (ERCP)-Guided Radiofrequency Ablation

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000708448.47665.8b ◽

2020 ◽

Vol 115 (1) ◽

pp. S815-S816

Author(s):

Steven Delaney ◽

Swati Pawa ◽

Rishi Pawa

Keyword(s):

Radiofrequency Ablation ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Hepatic Duct ◽

Endoscopic Retrograde ◽

Left Hepatic Duct ◽

Intraductal Papillary Neoplasm ◽

Papillary Neoplasm

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Intraductal papillary neoplasm of bile duct: all rare in one

BMJ Case Reports ◽

10.1136/bcr-2020-237001 ◽

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.

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Mucinous cystic neoplasm of the liver with biliary communication: case report and surgical therapeutic option

BMC Surgery ◽

10.1186/s12893-020-01003-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Raphaella Ferreira ◽

Phillipe Abreu ◽

Vagner Birk Jeismann ◽

Vanderlei Segatelli ◽

Fabricio Ferreira Coelho ◽

...

Keyword(s):

Bile Duct ◽

Hepatic Duct ◽

Therapeutic Option ◽

Mucinous Cystic Neoplasm ◽

Cystic Neoplasm ◽

Low Grade ◽

Mucinous Epithelium ◽

Biliary Communication ◽

Cystic Liver ◽

The Right

Abstract Background Mucinous cyst neoplasm of the liver (MCN-L) comprise less than 5% of all cystic liver lesions and is characterized by the presence of ovarian stroma and absence of bile duct communication. Case presentation Here, we discuss a 45-year-old woman who presented with symptomatic liver mass. Diagnostic workup detected a 4.2 × 3.6 cm septate cyst located in segments I, V, and VIII of the liver in communication with the right hepatic duct. An open right liver resection with total bile duct excision and hilar lymphadenectomy was performed. Pathology revealed a multiloculated cyst with lined mucinous epithelium and ovarian-like stroma, consistent with low-grade MCN-L. Conclusions This case shows that unusual location and bile duct communication can be present in MCN-L.

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Unusual presentation of a low-grade intraductal papillary neoplasm of the bile duct

Formosan Journal of Surgery ◽

10.1016/j.fjs.2014.11.003 ◽

2015 ◽

Vol 48 (2) ◽

pp. 68-71 ◽

Cited By ~ 1

Author(s):

Kian-Hwee Chong ◽

Chao-Chuan Wu ◽

Chia-Chi Wang ◽

Yi-Hsin Lee ◽

Yao-Jen Chang ◽

...

Keyword(s):

Bile Duct ◽

Unusual Presentation ◽

Low Grade ◽

Intraductal Papillary Neoplasm ◽

Papillary Neoplasm

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Intraductal Papillary Neoplasm of Bile Duct: Updated Clinicopathological Characteristics and Molecular and Genetic Alterations

Journal of Clinical Medicine ◽

10.3390/jcm9123991 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3991

Author(s):

Yasuni Nakanuma ◽

Katsuhiko Uesaka ◽

Yuko Kakuda ◽

Takashi Sugino ◽

Keiichi Kubota ◽

...

Keyword(s):

Bile Duct ◽

Biliary Tree ◽

Genetic Alterations ◽

High Grade Dysplasia ◽

Low Grade ◽

High Grade ◽

Intraductal Papillary Neoplasm ◽

Papillary Neoplasm

Intraductal papillary neoplasm of the bile duct (IPNB), a pre-invasive neoplasm of the bile duct, is being established pathologically as a precursor lesion of invasive cholangiocarcinoma (CCA), and at the time of surgical resection, approximately half of IPNBs show stromal invasion (IPNB associated with invasive carcinoma). IPNB can involve any part of the biliary tree. IPNB shows grossly visible, exophytic growth in a dilated bile duct lumen, with histologically villous/papillary neoplastic epithelia with tubular components covering fine fibrovascular stalks. Interestingly, IPNB can be classified into four subtypes (intestinal, gastric, pancreatobiliary and oncocytic), similar to intraductal papillary mucinous neoplasm of the pancreas (IPMN). IPNBs are classified into low-grade and high-grade based on lining epithelial features. The new subclassification of IPNB into types 1 (low-grade dysplasia and high-grade dysplasia with regular architecture) and 2 (high-grade dysplasia with irregular architecture) proposed by the Japan–Korea pathologist group may be useful in the clinical field. The outcome of post-operative IPNBs is more favorable in type 1 than type 2. Recent genetic studies using next-generation sequencing have demonstrated the existence of several groups of mutations of genes: (i) IPNB showing mutations in KRAS, GNAS and RNF43 belonged to type 1, particularly the intestinal subtype, similar to the mutation patterns of IPMN; (ii) IPNB showing mutations in CTNNB1 and lacking mutations in KRAS, GNAS and RNF43 belonged to the pancreatobiliary subtype but differed from IPMN. IPNB showing mutation of TP53, SMAD4 and PIK3CA might reflect complicated and other features characterizing type 2. The recent recognition of IPNBs may facilitate further clinical and basic studies of CCA with respect to the pre-invasive and early invasive stages.

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

Surgical Case Reports ◽

10.1186/s40792-021-01318-0 ◽

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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