Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, 411-8777, Japan; Department of Diagnostic Pathology, Fukui Prefecture Saiseikai Hospital, Fukui, 918-8503, Japan.
Department of Hepatobiliary Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, 411-8777, Japan.
Hum Pathol. 2021 May;111:21-35. doi: 10.1016/j.humpath.2021.01.002. Epub 2021 Jan 27.
The pathological spectrum of intraductal papillary neoplasm of bile duct (IPNB) remains to be clarified. A total of 186 IPNBs were pathologically examined using the type 1 and 2 subclassifications proposed by Japanese and Korean biliary pathologists incorporating a two-tiered grading system (low-grade and high-grade dysplasia), with reference to four subtypes (intestinal [i], gastric [g], pancreatobiliary [pb], and concocytic [o] subtype). IPNBs were classifiable into type 1 composed of low-grade dysplasia and 'high-grade dysplasia with regular structures' (69 IPNBs), and type 2 of 'high grade dysplasia with irregular structures and complicated lesions' (117 IPNBs). Type 1 was more common in the intrahepatic bile duct (78%), whereas type 2 was frequently located in the extrahepatic bile duct (58%). Mucin hypersecretion was more common in type 1 (61%) than in type 2 (37%). IPNBs were classifiable into the four subtypes: 86 iPNBs, 40 gIPNBs, 31 pbIPNBs, and 29 oIPNBs. The four subtypes were histologically evaluable with reference to the type 1 and 2 subclassifications. iIPNB and pbIPNBs were frequently classified as type 2, whereas types 1 and 2 were observed at similar rates in gIPNB and oIPNB. Stromal invasion was almost absent in type 1, irrespective of subtype, but was found in 66 of 117 type 2 IPNBs (P < .01), and postoperative outcome was favorable in IPNBs without invasion compared with IPNBs with invasion (P < .05). The type 1 and 2 subclassifications with reference to the four subtypes may provide useful information for understanding IPNB.
胆管内乳头状肿瘤（IPNB）的病理谱仍需阐明。共对 186 例 IPNB 进行了病理检查，采用了日本和韩国胆道病理学家提出的 1 型和 2 型分类，结合了双层分级系统（低级别和高级别异型增生），并参考了四种亚型（肠型[i]、胃型[g]、胰胆管型[pb]和浓缩型[o]）。IPNB 可分为 1 型，由低级别异型增生和“结构规则的高级别异型增生”组成（69 例），和 2 型，“结构不规则和复杂病变的高级别异型增生”（117 例）。1 型更常见于肝内胆管（78%），而 2 型更常见于肝外胆管（58%）。1 型的粘蛋白过度分泌更为常见（61%），而 2 型则更为少见（37%）。IPNB 可分为四个亚型：86 例 iPNB、40 例 gIPNB、31 例 pbIPNB 和 29 例 oIPNB。四个亚型可根据 1 型和 2 型分类进行组织学评估。iIPNB 和 pbIPNB 常被归类为 2 型，而 gIPNB 和 oIPNB 中 1 型和 2 型的发生率相似。1 型无论亚型均几乎无间质浸润，但在 117 例 2 型 IPNB 中有 66 例（P<.01）存在间质浸润，无浸润的 IPNB 术后预后优于有浸润的 IPNB（P<.05）。参考四个亚型的 1 型和 2 型分类可能为理解 IPNB 提供有用的信息。
