A patient who was diagnosed as IPN-B without hepatolithiasis?

Intraductal papillary neoplasm of the bile duct (IPN-B) is a neoplastic lesion preceding invasive intrahepatic cholangiocarcinoma (ICC) and is a new definition of a tumor with papillary growth in the intra- or extra-hepatic bile duct. The authors reported a case of IPN-B with interesting histopathological findings and emphasized that cholangiography is especially helpful for the diagnosis of bile duct dilatation due to the infiltration of carcinoma cells.

This case report, presented by a group led by Dr J Hayashi, is described in a research article to be published on March 14, 2008, in the World Journal of Gastroenterology.

This patient's laboratory data were within normal ranges and no solid mass was detected in her abdominal computed tomography (CT) scan or nuclear magnetic resonance imaging (MRI). However, endoscopic retrograde cholangiopancreatography (ERCP) demonstrated an obstruction of the right bile duct. ERCP is recommended to determine the presence and location of the suspected intraductal tumor before laparotomy. Intraoperative cholangiography showed stenosis of the intrahepatic bile duct in the anterior inferior segment (B5) and narrowness of the intrahepatic bile duct in the anterior superior segment (B8), so they strongly suspected intrahepatic cholangiocarcinoma (ICC). Histologically, surgically resected liver specimens, which are determined to be without tumor mass by macroscopic observation, showed intraductal papillary proliferation with fibrovascular cores and intraductal spreading of carcinoma in situ throughout a considerable area, especially in bile ductules around the peripheral small portal area. Furthermore, the immunohistochemical profile of the tumor (MUC5AC+/CK7+) was compatible with an intraductal papillary neoplasm of the bile duct (IPN-B). Consequently, this case was diagnosed as IPN-B with spreading CIS, stage I (pT1, pN0, P0, H1, M0). They reported a case of IPN-B with interesting histopathological findings and emphasized that cholangiography is especially helpful for the diagnosis of bile duct dilatation due to the infiltration of carcinoma cells.

Reference: Hayashi J, Matsuoka S, Inami £Í, Ohshiro S, Ishigami A, Fujikawa H, Miyagawa M, Mimatsu K, Kuboi Y, Kanou H, Oida T, Moriyama M. A case of asymptomatic intraductal papillary neoplasm of the bile duct without hepatolithiasis. World J Gastroenterol 2008; 14(10): 1625-1629
http://www.wjgnet.com/1007-9327/14/1625.asp

Correspondence to: Junpei Hayashi, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Itabashi-ku Tokyo 173-8610, Japan. jhayasi@nihon-u.med.ac.jp
Telephone: +81-3-3972-8111 Fax: +81-3-3956-8496

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