scholarly journals Intraductal papillary neoplasia of the bile duct (IPNB): case report and literature review

2020 ◽  
Vol 40 (3) ◽  
pp. 278
Author(s):  
Rómulo Vargas ◽  
Oscar Patarroyo ◽  
Raúl Cañadas ◽  
Alan Ovalle
Keyword(s):  
Bile Duct ◽  
Surgical Management ◽  
Curative Resection ◽  
Biliary Tree ◽  
Clinical Suspicion ◽  
Endoscopic Drainage ◽  
Palliative Intent ◽  
Intraductal Papillary Neoplasm ◽  
Abdominal Abscesses ◽  
First Case

Intraductal papillary neoplasm of the bile duct (IPNB) is a rare premalignant condition, defined as an epithelial neoplasm of the bile duct with exophytic papillary growth that can develop in any segment of the biliary tree. This pathology, with the highest prevalence in Asia, has been associated with the presence of hepatolithiasis and eastern liver infection (clonorchiasis). The diagnosis will depend on the clinical suspicion against the findings evidenced in the different diagnostic supports (invasive and non-invasive). Curative resection with negative margins is the treatment of choice in patients candidates for surgical management. In the event that the patient is not a candidate for curative resection, palliative treatment includes chemotherapy, percutaneous and endoscopic drainage, laser cholangioscopy ablation and intraluminal therapy with iridium 192. We present two cases of two patients with a diagnosis of IPNB confirmed by histology treated at our institution. The first case in an 86-yearold patient had a history of recurrent obstructive biliary syndrome and clinical suspicion of a new episode of cholangitis, and the second case in a 73-year-old patient who had a disseminated infectious process (spondylodiscitis, pelvic and intra-abdominal abscesses), and with the clinical suspicion of presenting a primary hepatobiliary focus. Both patients underwent single-operatorcholangioscopy plus biopsy, confirming the diagnosis by histology. The first case was managed with palliative intent, indicating endoscopic diversion of the bile duct, while surgical management was indicated in the second case.

scholarly journals Endoscopic ultrasonography-guided cholecystogastrostomy in a patient with pancreatic cancer: the first case in Colombia (with video)

2020 ◽  
Vol 35 (4) ◽  
pp. 527-532
Author(s):  
Renzo Pinto-Carta ◽  
Jaime Solano Mariño ◽  
Luis Felipe Cabrera Vargas ◽  
Erika Johana Benito Flórez
Keyword(s):  
Pancreatic Cancer ◽  
Bile Duct ◽  
Third World ◽  
Extrahepatic Bile Duct ◽  
Bile Leakage ◽  
Current Treatment ◽  
Curative Intent ◽  
Palliative Intent ◽  
First Case ◽  
Duodenal Invasion

The current treatment of malignant biliary obstruction is non-surgical biliary diversion with palliative intent, the surgery having specific indications in patients with malignant pathology with curative intent. However, duodenal obstruction and non-dilated intra- or extrahepatic bile duct make these surgical and endoscopic procedures guided by EUS difficult. We present our experience with the first case in Colombia a third-world country in Latin America of a cholecystogastrostomy guided by EUS in a patient with unresectable pancreatic cancer and duodenal invasion with dilated common bile duct using a luminal stent (LAMS) (HOT stent AXIOS; Xlumena Inc., Mountain View, CA, USA) 15mm x 10mm.EUS-guided cholecystogastrostomy should be considered as an option for biliary decompression of greater importance than percutaneous drainage since it is superior in terms of technical feasibility, safety and efficacy in specific cases of ampullary stenosis and duodenal invasion. In addition, it can be done in third world countries when it has the appropriate training and implements. The fully covered metal stent applied to light (HOT AXIOS stent, Xlumena Inc., Mountain View, CA, USA) is ideal for EUS guided cholecystogastrostomy to minimize complications such as bile leakage. Additional comparative studies are needed to validate the benefits of this technique.

scholarly journals A Curative Resection Case of Intraductal Papillary Neoplasm of the Bile Duct Followed by One Year

2011 ◽  
Vol 44 (8) ◽  
pp. 985-990
Author(s):  
Jun Muto ◽  
Ken Shirabe ◽  
Yohei Mano ◽  
Takashi Motomura ◽  
Kazuki Takeishi ◽  
...  
Keyword(s):  
Bile Duct ◽  
Curative Resection ◽  
Intraductal Papillary Neoplasm ◽  
One Year ◽  
Papillary Neoplasm

scholarly journals Intraductal papillary neoplasm of the bile duct: two case reports and review of the literature

2019 ◽  
Vol 6 (2) ◽  
pp. 25
Author(s):  
Vishal Kaila ◽  
Siddharth B Javia ◽  
Nirav Thosani ◽  
Isaac Raijman
Keyword(s):  
Bile Duct ◽  
Case Reports ◽  
Biliary Tree ◽  
Imaging Studies ◽  
Intraductal Papillary Neoplasm ◽  
Single Operator ◽  
Papillary Lesions ◽  
Extrahepatic Biliary Tree ◽  
Papillary Neoplasm ◽  
Made In

Background: Intraductal Papillary Neoplasm of the Bile Duct (IPNB) is a rare disease that is characterized by papillary lesions in the intra and extrahepatic biliary tree. Traditional imaging studies may show biliary dilation and/or filling defects. Endoscopic retrograde cholangiopancreatography can demonstrate diffuse bile duct dilatation as well as amorphous filling defects, however visualization of the biliary system can be limited by obstruction by the papillary lesions or mucin. Digital single operator cholangioscopy can be used to aid in diagnosis.Case Presentation: We report two elderly Caucasian males that presented with fatigue and obstructive jaundice. In both cases, the diagnosis of IPNB of was made. In one case, digital single operator cholangioscopy was used successfully to make the diagnosis.Conclusions: We present two cases of IPNB as well as a review of the clinical characteristics of IPNB and the utility of digital single operator cholangioscopy to aid in diagnosis. In IPNB, timely diagnosis is paramount. Traditional imaging studies can be inadequate, digital single operator cholangioscopy allows for quick diagnosis and, if indicated, further intervention. 

scholarly journals Spread of Intraductal Papillary Neoplasm Arising from the Cystic Duct of the Biliary Tree

2016 ◽  
Vol 10 (1) ◽  
pp. 7-16 ◽  
Author(s):  
Yoshihiko Kadowaki ◽  
Yuki Yokota ◽  
Satoshi Komoto ◽  
Nobuhito Kubota ◽  
Takahiro Okamoto ◽  
...  
Keyword(s):  
Bile Duct ◽  
Cystic Duct ◽  
Extrahepatic Bile Duct ◽  
Bile Duct Carcinoma ◽  
Biliary Tree ◽  
Duct Carcinoma ◽  
Intraductal Growth ◽  
Intraductal Papillary Neoplasm ◽  
Extrahepatic Bile Duct Resection ◽  
Papillary Neoplasm

Intraductal papillary neoplasm of the bile duct (IPNB) is a variant type of the bile duct carcinoma characterized by intraductal growth. IPNB is also recognized as a precursor of invasive carcinoma. We describe herein an extremely rare case of IPNB arising from the cystic duct. A 68-year-old man was admitted to our hospital for investigation of epigastralgia and abnormal levels of biliary tract enzyme. Computed tomography and magnetic resonance imaging showed a mass lesion spreading from the cystic duct to the upper-middle bile duct. Endoscopic retrograde cholangiography demonstrated diffuse duct dilation with a grossly visible intraductal mass and amorphous blobs, suggesting the presence of mucobilia or scattered tumors. We performed extrahepatic bile duct resection with lymphadenectomy. Macroscopically, a friable papillary tumor originated from the cystic duct grows intraluminally into the bile duct. Pathologically, the tumor was found to be intramucosal adenocarcinoma spreading to the whole extrahepatic bile duct, which was compatible with IPNB. We should discuss the features and progression processes of IPNB through this precious case.

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

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.

scholarly journals Simultaneous Extensive Intraductal Papillary Neoplasm of the Bile Duct and Pancreas: A Very Rare Entity

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Vor Luvira ◽  
Ake Pugkhem ◽  
Theerawee Tipwaratorn ◽  
Yaovalux Chamgramol ◽  
Chawalit Pairojkul ◽  
...  
Keyword(s):  
Bile Duct ◽  
Radical Surgery ◽  
Extrahepatic Bile Duct ◽  
Case Reports ◽  
Intrahepatic Bile Duct ◽  
Rare Entity ◽  
Intraductal Papillary Neoplasm ◽  
First Case ◽  
Slow Progression ◽  
Papillary Neoplasm

Intraductal papillary neoplasm of the bile duct (IPNB) is a specific type of bile duct tumor. It has been proposed that it could be the biliary counterpart of the intraductal papillary neoplasm of the pancreas (IPMN-P). This hypothesis is supported by the presence of simultaneous intraductal tumors of both the bile duct and pancreas. There have been five reports of patients with simultaneous IPNB and IPMN-P. In all of these cases, biliary involvement was limited to the intrahepatic and perihilar bile duct, which had characteristics similar to IPMN-P and usually had slow progression in nature. Herein, we present the first case of extensive intraductal neoplasm involving the extrahepatic bile duct, intrahepatic bile duct, and entire length of the pancreas with a poor outcome, even after being treated aggressively with radical surgery and adjuvant chemotherapy. Additionally, we summarize previous case reports of simultaneous intraductal lesions of the bile duct and pancreas.

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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