A case of pancreatobiliary reflux without pancreaticobiliary maljunction in which accessory pancreatic duct imaging was useful for the diagnosis

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.

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

10.21203/rs.3.rs-61716/v1 ◽

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.

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

10.21203/rs.3.rs-61716/v2 ◽

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.

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Acute obstructive suppurative pancreatic ductitis in pancreatic malignancies

Endoscopy International Open ◽

10.1055/a-1268-7086 ◽

2020 ◽

Vol 08 (12) ◽

pp. E1765-E1768

Author(s):

Ryoko Shimizuguchi ◽

Masataka Kikuyama ◽

Terumi Kamisawa ◽

Sawako Kuruma ◽

Kazuro Chiba

Keyword(s):

Abdominal Pain ◽

Pancreatic Duct ◽

Pancreatic Juice ◽

Myelogenous Leukemia ◽

Ductal Adenocarcinoma ◽

Klebsiella Pneumonia ◽

Duct Obstruction ◽

Pancreatic Duct Obstruction ◽

Nasopancreatic Drainage ◽

Accessory Pancreatic Duct

Abstract Background and study aims Acute obstructive suppurative pancreatic ductitis (AOSPD) is a suppurative pancreatic duct infection with main pancreatic duct (MPD) or accessory pancreatic duct obstruction in the absence of a pancreatic pseudocyst or necrosis, which is experienced usually in chronic pancreatitis. The diagnosis is confirmed by the finding of pancreatic duct obstruction on endoscopic retrograde cholangiopancreatography (ERCP) with evidence of infection, such as a positive pancreatic juice culture or drainage of purulent pancreatic juice. Patients and methods We studied five patients with pancreatic ductal adenocarcinoma (PDAC) and one with chronic myelogenous leukemia (CML), who suffered from AOSPD. Results Of the 281 PDAC and 39 CML patients who we treated in the past 2 years in our hospital, five with PDAC (1.8 %) and one with CML (2.6 %) experienced AOSPD. Each patient had fever, abdominal pain, and increased blood C-reactive protein. Pancreatography found that each patient had a MPD stricture and an upstream dilatation. Four had a disruption of the MPD in the upper stream of the stricture. Nasopancreatic drainage was successfully performed in all patients. Pancreatic juice culture was positive for Klebsiella pneumonia, Enterobacter agerogenes, or Enterococcus cloacae in four patients. Conclusion AOSPD should be considered in pancreatic malignancy with fever and abdominal pain. Prompt diagnosis of AOSPD could avoid shortening of survival of patients with an already poor prognosis by infection.

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