Terada Tadashi
Department of Pathology, Shizuoka City Shimizu Hospital Shizuoka, Japan.
Int J Clin Exp Pathol. 2012;5(1):96-101. Epub 2012 Jan 9.
Recently, several cases of intraductal oncocytic papillary neoplasm (IOPN) of the liver and hepatic bile ducts have been reported. The author herein reports the first case of IOPN of the common bile duct (CBD). A 78-year-old man was admitted to our hospital because of jaundice. Imaging modalities including US, CT, MRI revealed an intraductal tumor of the middle CBD and biliary dilation distal to the tumor. A partial resection of the CBD was performed. Grossly, a papillary tumor measuring 20 × 15 mm was found within the CBD. Mucus is absent. Histologically, the papillary tumor was composed of atypical oncocytes. The atypia was enough to be diagnosed as adenocarcinoma. No invasive features were noted. Immunohistochemically, the tumor cells were positive for pancytokeratins (CK), CK 7, CK 18, CK19, EMA, CA19-9, CEA, mitochondria, p53 protein, C-erbB2, Ki-67 (labeling = 80%), MUC2, MUC5AC and MUC-6,. The tumor cells were negative for CK8, CK20, chromogranin, synaptophysin, neuron-specific enolase, S100 protein, CD56, MUC1, CD10 and CDX2. These immunohistochemical findings were compatible with IOPN. The patient died of other non-tumorous disease 7 year after the operation. In summary, the author presented the first case of IOPN of the CBD.
最近，有几例肝内和肝内胆管导管内嗜酸性乳头状肿瘤（IOPN）的病例被报道。本文作者报告了首例胆总管（CBD）的IOPN病例。一名78岁男性因黄疸入院。包括超声、CT、MRI在内的影像学检查显示胆总管中部有导管内肿瘤，肿瘤远端胆管扩张。对胆总管进行了部分切除。大体上，在胆总管内发现一个大小为20×15mm的乳头状肿瘤。无黏液。组织学上，乳头状肿瘤由非典型嗜酸性细胞组成。非典型性足以诊断为腺癌。未发现浸润性特征。免疫组化方面，肿瘤细胞对全细胞角蛋白（CK）、CK 7、CK 18、CK19、EMA、CA19-9、CEA、线粒体、p53蛋白、C-erbB2、Ki-67（标记率=80%）、MUC2、MUC5AC和MUC-6呈阳性。肿瘤细胞对CK8、CK20、嗜铬粒蛋白、突触素、神经元特异性烯醇化酶、S100蛋白、CD56、MUC1、CD10和CDX2呈阴性。这些免疫组化结果与IOPN相符。患者术后7年死于其他非肿瘤性疾病。总之，作者报告了首例胆总管IOPN病例。
