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Year : 2014  |  Volume : 57  |  Issue : 1  |  Page : 144-145
Intraductal papillary neoplasm of the bile duct: A rarity


1 Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

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Date of Web Publication17-Apr-2014
 

How to cite this article:
Bal MM, Goel M, Ramadwar M, Deodhar K. Intraductal papillary neoplasm of the bile duct: A rarity. Indian J Pathol Microbiol 2014;57:144-5

How to cite this URL:
Bal MM, Goel M, Ramadwar M, Deodhar K. Intraductal papillary neoplasm of the bile duct: A rarity. Indian J Pathol Microbiol [serial online] 2014 [cited 2021 Oct 25];57:144-5. Available from: https://www.ijpmonline.org/text.asp?2014/57/1/144/130929


A 28-year-old woman presented with abdominal pain and increasing yellowness of skin and conjunctiva. Except for presence of icterus, general physical examination was within the normal limits. Pre-operative investigations revealed raised serum bilirubin-8.2 mg/dL (0.3-1.2 mg/dL), globulins - 4.1 g/dL (1.7-3.5 g/dl), alkaline phosphatase - 251 U/L (30-120 U/L), SGOT - 47 U/L (10-37 U/L) and SGPT-44 U/L (10-37 U/L). Serum CA19.9 level was 46.61 U/mL (0-37 U/mL). Duodenal stenosis pre-empted feasibility of endoscopic-retrograde cholangiopancreatography. Computed tomography of abdomen revealed a 1 cm hypodense mass in the pancreatic head. With a pre-operative diagnosis of carcinoma head of pancreas, a pylorus-preserving pancreatoduodenectomy was performed. Macroscopic examination discovered a firm, whitish-gray papillary tumor germinating in the common bile duct, 1 cm from the ampullary end, measuring 0.9 cm in greatest dimension and nearly occluding its ectatic lumen [Figure 1]. No gross invasion into the pancreatic parenchyma, ampulla or duodenum was identified. Microscopy revealed a non-invasive, intraductal complex papillary neoplasm lined by pancreatobiliary lining epithelium and exhibiting high grade dysplasia [Figure 2]. All resection margins and regional nodes were uninvolved. A diagnosis of intraductal papillary neoplasm of the bile duct (IPNB) was rendered. IPNB is a macroscopically discernible precursor lesion of cholangiocarcinoma and shares substantial histological and biological overlap with its more elaborately described and renowned counterpart in the pancreatic ducts, namely the intraductal papillary mucinous neoplasms (IPMN). [1],[2],[3],[4] Although established to harbor p53 and SMAD4 mutations, complete molecular character of this fascinating precursor lesion remains to be decoded. These lesions can arise anywhere along the biliary tree; commonest location is the hilar (16%) followed by distal common bile duct (11%) and intra-hepatic (5%) amongst all biliary mass resections. [4] Similar to IPMN, these lesions exhibit four types of lining epithelia: Pancreaticobiliary, intestinal, gastric and oncocytic type. [4] IPNB tends to propagate along the bile duct mucosal surface and harbors a propensity to become invasive in approximately 74% cases and therefore, necessitates a complete excision. [4] Presence and depth of tumor invasion, margin-positive resection and expression of MUC1 and carcinoembryonic antigen are associated with worse survival. [4] Albeit, prognosis of non-invasive and completely resected IPNB is excellent. The patient at last follow-up (8 months post-operative) was asymptomatic and had no evidence of disease.
Figure 1: Pancreatic-head axial slices revealed a dilated common bile duct lumen filled with intraductal papillary neoplasm of the bile duct. Normal main pancreatic duct is seen within the pancreatic parenchyma
in the lower part


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Figure 2: Microphotograph of non-invasive intraductal papillary neoplasm of the bile duct lined by pancreatobiliary epithelium and exhibiting grade 3 dysplasia (H and E, original magnification 10)

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   References Top

1.Abraham SC, Lee JH, Hruban RH, Argani P, Furth EE, Wu TT. Molecular and immunohistochemical analysis of intraductal papillary neoplasms of the biliary tract. Hum Pathol 2003;34:902-10.  Back to cited text no. 1
    
2.Klöppel G, Kosmahl M. Is the intraductal papillary mucinous neoplasia of the biliary tract a counterpart of pancreatic papillary mucinous neoplasm? J Hepatol 2006;44:249-50.  Back to cited text no. 2
    
3.Zen Y, Fujii T, Itatsu K, Nakamura K, Minato H, Kasashima S, et al. Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas. Hepatology 2006;44:1333-43.  Back to cited text no. 3
    
4.Rocha FG, Lee H, Katabi N, DeMatteo RP, Fong Y, D'Angelica MI, et al. Intraductal papillary neoplasm of the bile duct: A biliary equivalent to intraductal papillary mucinous neoplasm of the pancreas? Hepatology 2012;56:1352-60.  Back to cited text no. 4
    

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Correspondence Address:
Munita Meenu Bal
Department of Pathology, Tata Memorial Hospital, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.130929

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