Nakanuma Yasuni, Uesaka Katsuhiko, Miyayama Shiro, Yamaguchi Hiroshi, Ohtsuka Masayuki
Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan.
Department of Diagnostic Pathology, Fukui Saiseikai Hospital, Fukui, Japan.
Histol Histopathol. 2017 Oct;32(10):1001-1015. doi: 10.14670/HH-11-892. Epub 2017 Mar 24.
Invasive biliary tract carcinomas are usually tubular adenocaricnomas with abundant desmoplastic reactions and frequent ductal and periductal invasion at the time of the diagnosis. Recently, several intraductal neoplasms of the bile duct, particularly at a pre-invasive stage, have been recognized. They include intraductal papillary neoplasm of the bile duct (IPNB), biliary intraepithelial neoplasm (BilIN), and others, such as intraductal tubulopapillary neoplasm (ITPN) of the bile duct. IPNBs are grossly visible predominantly intraductal-growing papillary neoplasms covered by well-differentiated neoplastic epithelium with fine fibrovascular cores in the dilated bile ducts. Regarding their similarities to intraductal papillary mucinous neoplasm of the pancreas (IPMN) of main pancreatic duct type, some IPNBs resemble IPMN ("pancreatic type"), while others are only somewhat similar or variably different from IPMN ("non-pancreatic type"). Some IPNBs develop via a common oncogenic signaling pathway, and others, particularly those of intestinal type, frequently show GNAS mutations, as in IPMN. BilINs are a microscopically recognizable flat or micropapillary pre-invasive neoplasm and are presumed to precede conventional nodular-sclerosing cholangiocarcinomas. ITPN of the bile duct is a rare neoplasm composed of densely packed tubular glands. These three types of neoplasms are not infrequently associated with invasive adenocarcinoma. Pre-invasive intraglandular neoplasms of the peribiliary glands, another epithelial system in the biliary tree, have been also reported. Further characterization of these intraductal and intraglandular neoplasms of the bile duct is needed to overcome devastating invasive biliary tract carcinoma.
浸润性胆管癌通常为管状腺癌，诊断时伴有大量促纤维增生反应，且常出现导管及导管周围浸润。近来，人们认识到几种胆管内肿瘤，尤其是处于浸润前阶段的肿瘤。它们包括胆管内乳头状肿瘤（IPNB）、胆管上皮内肿瘤（BilIN）以及其他类型，如胆管内管状乳头状肿瘤（ITPN）。IPNB大体上主要表现为在扩张胆管内生长的乳头状肿瘤，表面覆盖有分化良好的肿瘤上皮，伴有纤细的纤维血管轴心。就其与主胰管型胰腺导管内乳头状黏液性肿瘤（IPMN）的相似性而言，一些IPNB类似于IPMN（“胰腺型”），而另一些则仅与IPMN有一定相似性或存在不同程度差异（“非胰腺型”）。一些IPNB通过共同的致癌信号通路发展而来，其他类型，尤其是肠型IPNB，常表现出GNAS突变，与IPMN情况相同。BilIN是一种在显微镜下可识别的扁平或微乳头状浸润前肿瘤，被认为是传统结节硬化型胆管癌的前驱病变。胆管ITPN是一种罕见肿瘤，由密集排列的管状腺体组成。这三种肿瘤类型常与浸润性腺癌相关。胆管周围腺体的浸润前腺内肿瘤是胆管树中的另一种上皮系统，也有相关报道。为攻克具有破坏性的浸润性胆管癌，需要对这些胆管内和腺内肿瘤进行进一步的特征描述。
