A case of asymptomatic intraductal papillary neoplasm of the bile duct without hepatolithiasis

A 65-year-old woman was found to have dilatation of the intrahepatic bile duct in the right anterior segment during a general health. Laboratory data were within normal ranges and no solid mass was detected in her abdominal computer tomography （CT） or nuclear magnetic resonance imaging （MRI）. Howeve...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2008-03, Vol.14 (10), p.1625-1629
Main Authors: Hayashi, Junpei, Matsuoka, Shyunichi, Inami, Makiko, Ohshiro, Shu, Ishigami, Akiyasu, Fujikawa, Hirotoshi, Miyagawa, Masahide, Mimatsu, Kenji, Kuboi, Youichi, Kanou, Hisao, Oida, Takatsugu, Moriyama, Mitsuhiko
Format: Article
Language:English
Subjects:
Aged
Bile Duct Neoplasms - diagnosis
Bile Duct Neoplasms - surgery
Carcinoma, Intraductal, Noninfiltrating - diagnosis
Carcinoma, Intraductal, Noninfiltrating - surgery
Carcinoma, Papillary - diagnosis
Carcinoma, Papillary - surgery
Case Report
Cholangiography
Female
Hepatectomy
Humans
Lithiasis
Liver Diseases
管内突状瘤
肝内胆管癌
肝切除术
肝结石
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Summary:A 65-year-old woman was found to have dilatation of the intrahepatic bile duct in the right anterior segment during a general health. Laboratory data were within normal ranges and no solid mass was detected in her abdominal computer tomography （CT） or nuclear magnetic resonance imaging （MRI）. However, endoscopic retrograde cholangiopancreatography （ERCP） demonstrated an obstruction of the right bile duct. 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 that we strongly suspected intrahepatic cholangiocarcinoma （ICC）. Histologically, surgically resected liver specimens, 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, stageⅠ（pT1, pN0, P0, H1, M0）. We report a case of IPN-B with interesting histopathologicalfindings and emphasize that cholangiography is especially helpful for the diagnosis of bile duct dilatation due to infiltration of carcinoma cells.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.14.1625