Hayashi J, Matsuoka SI, Inami M, Ohshiro S, Ishigami A, Fujikawa H, Miyagawa M, Mimatsu K, Kuboi Y, Kanou H, Oida T, Moriyama M. A case of asymptomatic intraductal papillary neoplasm of the bile duct without hepatolithiasis. World J Gastroenterol 2008; 14(10): 1625-1629 [PMID: 18330960 DOI: 10.3748/wjg.14.1625]
Corresponding Author of This Article
Junpei Hayashi, Division of Gastroentero-logy and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Tokyo 173-8610, Japan. jhayasi@nihon-u.med.ac.jp
Article-Type of This Article
Case Report
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Junpei Hayashi, Shyun-ichi Matsuoka, Makiko Inami, Shu Ohshiro, Akiyasu Ishigami, Hirotoshi Fujikawa, Masahide Miyagawa, Department of Gastroenterology, Social Insurance Yokohama Central Hospital, Yokohama 231-8553, Japan
Kenji Mimatsu, Youichi Kuboi, Hisao Kanou, Takatsugu Oida, Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama 231-8553, Japan
Junpei Hayashi, Makiko Inami, Shu Ohshiro, Mitsuhiko Moriyama, Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
Author contributions: Hayashi J wrote the paper; Matsuoka S, Inami M, Ohshiro S, Fujikawa H, Ishikami A and Miyagawa M treated patient with some examinations; Fujikawa H analyzed the histopathological findings; Mimatsu K, Kuboi Y, Kanou H, and Oida T performed hepatectomy; Moriyama M contributed to get the diagnosis.
Correspondence to: Junpei Hayashi, Division of Gastroentero-logy and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi-Kamimachi, Tokyo 173-8610, Japan. jhayasi@nihon-u.med.ac.jp
Telephone: +81-3-39728111
Fax: +81-3-39568496
Received: November 21, 2007 Revised: January 30, 2008 Published online: March 14, 2008
Abstract
A 65-year-old woman was found to have dilatation of the intrahepatic bile duct in the right anterior segment during a general health. Laboratory data were within normal ranges and no solid mass was detected in her abdominal computer tomography (CT) or nuclear magnetic resonance imaging (MRI). However, endoscopic retrograde cholangiopancreatography (ERCP) demonstrated an obstruction of the right bile duct. Intraoperative cholangiography showed stenosis of the intrahepatic bile duct in the anterior inferior segment (B5) and narrowness of the intrahepatic bile duct in the anterior superior segment (B8), so that we strongly suspected intrahepatic cholangiocarcinoma (ICC). Histologically, surgically resected liver specimens, without tumor mass by macroscopic observation, showed intraductal papillary proliferation with fibrovascular cores and intraductal spreading of carcinoma in situ throughout a considerable area, especially in bile ductules around the peripheral small portal area. Furthermore, the immunohistochemical profile of the tumor (MUC5AC+/CK7+) was compatible with an intraductal papillary neoplasm of the bile duct (IPN-B). Consequently, this case was diagnosed as IPN-B with spreading CIS, stageI(pT1, pN0, P0, H1, M0). We report a case of IPN-B with interesting histopathological findings and emphasize that cholangiography is especially helpful for the diagnosis of bile duct dilatation due to infiltration of carcinoma cells.
