Yasuda Koji, Kashu Nozomi, Mushiake Yutaka, Takami Tomoya, Shintani Hiroshi, Kataoka Naoki, Yamaguchi Tomoyuki, Makimoto Shinichiro
Dept. of Surgery, Kishiwada Tokushukai Hospital.
Gan To Kagaku Ryoho. 2022 Apr;49(4):482-485.
Intraductal papillary neoplasm of bile duct(IPNB)is a papillary tumor that develops in the bile duct inside and outside the liver, and is a relatively new disease concept recognized as a precancerous/early cancer lesion of bile duct cancer.
A 74-year-old woman. A nearby doctor pointed out liver dysfunction in a medical examination, and he was introduced for the purpose of detailed examination. No subjective symptoms were observed. The blood sampling test showed no increase in tumor markers. Abdominal CT/MRI examination and abdominal echo examination showed multiple nodules from the origin of the left intrahepatic bile duct and intrahepatic bile duct dilation predominantly on the left side. No other findings indicating metastasis were found, including the PET-CT test. Endoscopic retrograde cholangiography revealed a poorly contrast-enhanced area in the B3 region, and intraluminal ultrasonography confirmed a mass that coincided with the poorly contrast-enhanced area and grew papillary. No tumor growth was observed in the other branches or common bile ducts, but all ducts were filled with suspended matter, which was thought to be mucus. Histopathological examination of the tumor biopsy revealed atypical epithelium with papillary structure and moderate nuclear atypia. A diagnosis of intraductal papillary tumor was made, and left hepatic lobectomy was performed. Postoperative histopathological examination revealed a complex papillary growth of highly dysplastic mucus-producing epithelium similar to the pancreatic duct/bile duct epithelium, and no obvious infiltrative growth. The postoperative course was uneventful, and the patient was discharged 16 days after the operation. Currently, 6 months after the operation, he is outpatient without recurrence. We report a case of intraductal papillary tumor that had a favorable course after surgical resection in the preoperative diagnosis, with some review of the literature.
胆管内乳头状肿瘤（IPNB）是一种发生于肝内外胆管的乳头状肿瘤，是一种相对较新的疾病概念，被认为是胆管癌的癌前/早期癌病变。
一名74岁女性。附近医生在体检时指出肝功能异常，遂将其转诊以进行详细检查。未观察到主观症状。血液采样检查显示肿瘤标志物未升高。腹部CT/MRI检查及腹部超声检查显示左肝内胆管起始部有多个结节，且主要为左侧肝内胆管扩张。包括PET-CT检查在内，未发现其他提示转移的迹象。内镜逆行胆管造影显示B3区域造影剂增强不佳，管腔内超声证实有一肿块与造影剂增强不佳区域相符且呈乳头状生长。其他分支或胆总管未观察到肿瘤生长，但所有胆管内均充满悬浮物，考虑为黏液。肿瘤活检的组织病理学检查显示具有乳头状结构的非典型上皮及中度核异型性。诊断为胆管内乳头状肿瘤，并进行了左肝叶切除术。术后组织病理学检查显示高度发育异常的黏液分泌上皮呈复杂乳头状生长，类似于胰管/胆管上皮，且无明显浸润性生长。术后病程顺利，患者术后16天出院。目前，术后6个月，门诊随访无复发。我们报告一例术前诊断为胆管内乳头状肿瘤，手术切除后病程良好的病例，并对相关文献进行一些回顾。
