Department of Digestive Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
Surg Today. 2012 Dec;42(12):1240-3. doi: 10.1007/s00595-012-0233-6. Epub 2012 Jun 28.
We report a rare case of an intraductal oncocytic papillary neoplasm (IOPN) of the extrahepatic bile duct. A 66-year-old man was admitted to our hospital for investigation of right-sided back pain. Ultrasonography, computed tomography and magnetic resonance imaging showed a papillary lesion, 3 cm in diameter, in the middle bile duct, invaginating into the cystic duct. We made a provisional diagnosis of middle bile duct cancer and performed substomach-preserving pancreatoduodenectomy. Macroscopically, the middle bile duct contained a two-humped papillary tumor, one tip of which invaginated into the cystic duct. Microscopically, the tumor consisted of cuboidal cells with abundant eosinophilic cytoplasm resembling that of oncocytes and a fine fibrovascular core. The tumor cells were stained strongly with antimitochondria antibody. Based on these findings, the tumor was diagnosed histologically as IOPN of the extrahepatic bile duct. The patient died of prostate cancer 51 months after surgery, but without evidence of recurrence of the IOPN.
我们报告一例罕见的肝外胆管内嗜酸细胞性乳头状肿瘤（IOPN）。一名 66 岁男性因右侧背痛就诊于我院。超声、CT 和 MRI 显示直径 3cm 的胆管中段有一个乳头状病变，向胆囊管内凹陷。我们初步诊断为胆管中段癌，并进行了保留胃的胰十二指肠切除术。大体上，胆管中段有两个驼峰状的乳头状肿瘤，其中一个尖端向胆囊管内凹陷。镜下，肿瘤由具有丰富嗜酸性细胞质的立方细胞组成，类似于嗜酸性细胞瘤，并有精细的纤维血管核心。肿瘤细胞强烈染色抗线粒体抗体。根据这些发现，肿瘤组织学诊断为肝外胆管 IOPN。患者术后 51 个月死于前列腺癌，但无 IOPN 复发证据。
