Ikenaga Naoki, Komatsu Hisateru, Nishizawa Yujiro, Inoue Akira, Miyazaki Yasuhiro, Komori Takamichi, Motoori Masaaki, Tomokuni Akira, Fushimi Hiroaki, Fujitani Kazumasa, Iwase Kazuhiro
Dept. of Gastroenterological Surgery, Osaka General Medical Center.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2398-2400.
Case 1: A man in his 70s was referred to our hospital for further examination of a liver tumor(S3, 3 cm)detected by ultrasonography. Multimodal image examination showed a cystic lesion with solid papillary components located in the S4 accompanied by dilatation of the surrounding intrahepatic bile duct. Although biliary cytology did not indicate confirmed malignancy, the lesion was thought to be an intraductal papillary neoplasm of bile duct(IPNB)with malignant potential, and a left lobectomy was performed. Histopathological examination revealed a papillary tumor in the intrahepatic bile duct which consisted of atypical epithelial cells of pancreatobiliary type, and the lesion was diagnosed as an IPNB with high-grade intraepithelial neoplasia. Case 2: A woman in her 70s was referred to our hospital because of a liver tumor(S4, 8 cm)detected by ultrasonography. Multimodal image examination showed a cystic lesion localized to the liver(S3, 8 cm), and endoscopic retrograde cholangiopancreatography(ERCP)showed continuity of the cyst and the intrahepatic bile duct. The biliary cytology was positive, and the lesion was thought to be a malignant IPNB. After preoperative drainage of the cystic lesion, a left lobectomy was conducted. Histopathological examination showed that the papillary tumor localized to the bile duct and atypical epithelium cells of pancreatobiliary type were infiltrating into the surrounding matrix. We diagnosed this tumor as an IPNB with an associated invasive carcinoma.
病例1：一名70多岁男性因超声检查发现肝脏肿瘤（S3段，3厘米）转诊至我院进一步检查。多模态影像检查显示，S4段有一个伴有周围肝内胆管扩张的含实性乳头状成分的囊性病变。尽管胆汁细胞学检查未提示确诊为恶性肿瘤，但该病变被认为是具有恶性潜能的胆管内乳头状肿瘤（IPNB），遂行左半肝切除术。组织病理学检查显示肝内胆管有一个由胰胆管型非典型上皮细胞组成的乳头状肿瘤，该病变被诊断为高级别上皮内瘤变的IPNB。病例2：一名70多岁女性因超声检查发现肝脏肿瘤（S4段，8厘米）转诊至我院。多模态影像检查显示肝脏（S3段，8厘米）有一个局限性囊性病变，内镜逆行胰胆管造影（ERCP）显示囊肿与肝内胆管相连。胆汁细胞学检查呈阳性，该病变被认为是恶性IPNB。在对囊性病变进行术前引流后，行左半肝切除术。组织病理学检查显示，胆管内局限性乳头状肿瘤及胰胆管型非典型上皮细胞浸润周围基质。我们将此肿瘤诊断为伴有浸润性癌的IPNB。
