|
1
|
Zeng D, Li B, Cheng N. Prognostic factors for intraductal papillary neoplasm of the bile duct following surgical resection: a systematic review and meta-analysis. Surg Today 2025; 55:131-143. [PMID: 39424711 DOI: 10.1007/s00595-024-02948-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 09/29/2024] [Indexed: 10/21/2024]
Abstract
Intraductal papillary neoplasm of the bile duct (IPNB) is a biliary neoplasm characterized by intraductal papillary growth and varying degrees of malignant transformation. This study aimed to identify effective prognostic factors (PFs) for predicting the prognosis of IPNB after surgical resection, addressing the gap in the higher level evidence. We systematically searched databases from their inception to October 10, 2023. Data on 12 predetermined PFs were collected and subjected to a meta-analysis. Forest plots were used to summarize the findings. Fifteen studies with a total of 2311 patients were included. Among the PFs examined, extrahepatic tumor location (HR, 2.97; 95% CI 1.68-5.23), subclassification type 2 (HR, 2.62; 95% CI 1.45-4.76), R1 resection (HR, 2.47; 95% CI 1.73-3.51), elevated CA19-9 level (HR, 3.25; 95% CI 1.91-5.54), tumor multiplicity (HR, 2.65; 95% CI 1.40-5.02), and adjacent organ invasion (HR, 3.17; 95% CI 2.01-5.00) were associated with a poorer prognosis. Additionally, the combined HR values indicated that lymph node metastasis and poor tumor differentiation were linked to a worse prognosis, although both exhibited significant heterogeneity. Our study offers valuable insights for enhancing postoperative prognostication and treatment decision-making for IPNB patients with IPNB. These findings warrant further validation in future prospective studies.
Collapse
Affiliation(s)
- Di Zeng
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Bei Li
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Nansheng Cheng
- Division of Biliary Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
|
2
|
Varshney P, Varshney VK, Saikrishna E. ASO Author Reflections: Simplifying Complex Biliary Reconstruction in Parenchyma-Preserving Liver Surgery. Ann Surg Oncol 2024; 31:9227-9228. [PMID: 39145827 DOI: 10.1245/s10434-024-16076-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 08/01/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Peeyush Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Eswaravaka Saikrishna
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
|
3
|
Saikrishana E, Varshney P, Varshney VK, Soni SC, Selvakumar B, Agarwal L. En Bloc Extrahepatic Biliary Tract Excision with Triple Cholangiojejunostomy for Complex Hilar Intraductal Papillary Neoplasm of the Liver. Ann Surg Oncol 2024; 31:6947-6950. [PMID: 39085553 DOI: 10.1245/s10434-024-15954-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024]
Affiliation(s)
- E Saikrishana
- All India Institute of Medical Sciences, Jodhpur, India
| | - Peeyush Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India.
| | - Vaibhav Kumar Varshney
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Subash Chandra Soni
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - B Selvakumar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| | - Lokesh Agarwal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, India
| |
Collapse
|
|
4
|
Onoe M, Fukuba N, Kodama Y, Oka A, Kawashima K, Shibagaki K, Ishimura N, Kushiyama Y, Uchida Y, Furukawa T, Ishihara S. Multiple intraductal papillary neoplasms of bile duct diagnosed based on endoscopic ultrasonography and peroral cholangioscopy findings. Clin J Gastroenterol 2024; 17:962-969. [PMID: 38971959 PMCID: PMC11436404 DOI: 10.1007/s12328-024-02000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/02/2024] [Indexed: 07/08/2024]
Abstract
A man in his 30s was referred to our department for evaluation of bile duct stricture and removal of an intrahepatic bile duct stone. Five years before his presentation, he underwent left hepatectomy for a giant hepatic hemangioma. There were no abnormalities in blood biochemical tests. Magnetic resonance cholangiopancreatography showed one 5 mm oval defect in region B6 and two 8 mm semicircular defects in the hilar bile duct. Endoscopic ultrasound revealed a 3.5 mm hypoechoic focal raised lesion in the hilar bile duct. Oral cholangioscopy revealed his two lesions in the hilar bile duct as white papillary elevations with mucus production. The pathological diagnosis of intraductal papillary neoplasm was determined (low-grade dysplasia, type 1, gastric type). After 1 and a half years, no expansion of the bile duct lesion was observed. Initially, it was thought to be a benign stenosis after liver resection, but based on the results of endoscopic ultrasound, we suspected a tumorous lesion, and we were able to make an accurate diagnosis, including histological type, using transoral cholangioscopy.
Collapse
Affiliation(s)
- Masaki Onoe
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1, Enya-cho, Izumo, Shimane, Japan
| | - Nobuhiko Fukuba
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1, Enya-cho, Izumo, Shimane, Japan.
| | - Yasuhide Kodama
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1, Enya-cho, Izumo, Shimane, Japan
| | - Akihiko Oka
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1, Enya-cho, Izumo, Shimane, Japan
| | - Kousaku Kawashima
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1, Enya-cho, Izumo, Shimane, Japan
| | - Kotaro Shibagaki
- Division of Endoscopy, Shimane University Hospital, Izumo, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1, Enya-cho, Izumo, Shimane, Japan
| | - Yoshinori Kushiyama
- Department of Gastroenterology, Matsue Red Cross Hospital, Izumo, Shimane, Japan
| | - Yasushi Uchida
- Department of Gastroenterology, Matsue Red Cross Hospital, Izumo, Shimane, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shunji Ishihara
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, 89-1, Enya-cho, Izumo, Shimane, Japan
| |
Collapse
|
|
5
|
Jeon SK, Lee JM, Yoo J, Park S, Joo I, Yoon JH, Lee KB. Intraductal papillary neoplasm of the bile duct: diagnostic value of MRI features in differentiating pathologic subclassifications-type 1 versus type 2. Eur Radiol 2024; 34:4674-4685. [PMID: 38114846 DOI: 10.1007/s00330-023-10491-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/10/2023] [Accepted: 10/25/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To identify MRI features for differentiating type 2 from type 1 intraductal papillary neoplasms of bile duct (IPNB) and assessing malignant potential of IPNB. METHODS This retrospective study included 60 patients with surgically proven IPNB who had undergone preoperative MRI between January 2007 and December 2020. All surgical specimens were reviewed retrospectively to classify types 1 and 2 IPNBs and assess tumor grade. Significant MRI features for differentiating type 2 (n = 40) from type 1 IPNB (n = 20); and for IPNB with an associated invasive carcinoma (n = 43) from intraepithelial neoplasia (n = 17) were determined using logistic regression analysis. RESULTS An associated invasive carcinoma was more frequently found in type 2 than in type 1 IPNB (85.0% [34/40] vs. 45.0% [9/20], p = 0.003). At univariable analysis, MRI features including extrahepatic location, no dilatation of tumor-bearing segment of bile duct, isolated upstream bile duct dilatation, and single lesion were associated with type 2 IPNB (all p ≤ 0.012). At multivariable analysis, significant MRI findings for differentiating type 2 from type 1 IPNB were extrahepatic location and no dilatation of tumor-bearing segment of bile duct (odds ratio [OR], 7.24 and 46.40, respectively). At univariable and multivariable analysis, tumor size ≥ 2.5 cm (OR, 8.45), bile duct wall thickening (OR, 4.82), and irregular polypoid or nodular tumor shape (OR, 6.44) were significant MRI features for differentiating IPNB with an associated invasive carcinoma from IPNB with intraepithelial neoplasia. CONCLUSION MRI with MR cholangiopancreatography may be helpful in differentiating type 2 IPNB from type 1 IPNB and assessing malignant potential of IPNB. CLINICAL RELEVANCE STATEMENT Preoperative MRI with MR cholangiopancreatography may be helpful in differentiating type 2 intraductal papillary neoplasms of bile duct (IPNB) from type 1 IPNB and assessing malignant potential of IPNB. KEY POINTS • In terms of tumor grade, the incidence of invasive carcinoma was significantly higher in type 2 intraductal papillary neoplasm of the bile duct (IPNB) than in type 1 IPNB. • At MRI, extrahepatic location and no dilatation of tumor-bearing segment are significant features for differentiating type 2 IPNBs from type 1 IPNBs. • At MRI, large tumor size, bile duct wall thickening, and irregular polypoid or nodular tumor shape are significant features for differentiating IPNB with an associated invasive carcinoma from IPNB with intraepithelial neoplasia.
Collapse
Affiliation(s)
- Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehangno, Jongno-Gu, Seoul, 03080, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehangno, Jongno-Gu, Seoul, 03080, Korea.
| | - Jeongin Yoo
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehangno, Jongno-Gu, Seoul, 03080, Korea
| | - Sungeun Park
- Department of Radiology, Konkuk University Medical Center, Seoul, South Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehangno, Jongno-Gu, Seoul, 03080, Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehangno, Jongno-Gu, Seoul, 03080, Korea
| | - Kyoung Bun Lee
- Department of Pathology, Seoul National University Hospital, Seoul, South Korea
| |
Collapse
|
|
6
|
Lluís N, Onoe S, Serradilla-Martín M, Achalandabaso M, Mizuno T, Jehaes F, Dasari BVM, Mambrilla-Herrero S, Sparrelid E, Balakrishnan A, Hoogwater FJH, Amaral MJ, Andersson B, Berrevoet F, Doussot A, López-López V, Detry O, Pozo CDD, Machairas N, Pekli D, Alcázar-López CF, Asbun H, Björnsson B, Christophides T, Díez-Caballero A, Francart D, Noel CB, Sousa-Silva D, Toledo-Martínez E, Tzimas GN, Yaqub S, Yamaguchi J, Dokmak S, Prieto-Calvo M, D'Souza MA, Spiers HVM, van den Heuvel MC, Charco R, Lesurtel M, Ebata T, Ramia JM. Intraductal papillary neoplasms of the bile ducts: a comparative study of a rare disease in Europe and Nagoya, Japan. HPB (Oxford) 2024; 26:565-575. [PMID: 38307773 DOI: 10.1016/j.hpb.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/27/2023] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Intraductal papillary neoplasm of the bile ducts (IPNB) is a rare disease in Western countries. The aim of this study was to compare tumor characteristics, management strategies, and outcomes between Western and Eastern patients who underwent surgical resection for IPNB. METHODS A multi-institutional retrospective series of patients with IPNB undergoing surgery between January 2010 and December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA), and at Nagoya University Hospital, Japan. RESULTS A total of 85 patients (51% male; median age 66 years) from 28 E-AHPBA centers were compared to 91 patients (64% male; median age 71 years) from Nagoya. Patients in Europe had more multiple lesions (23% vs 2%, P < .001), less invasive carcinoma (42% vs 85%, P < .001), and more intrahepatic tumors (52% vs 24%, P < .001) than in Nagoya. Patients in Europe experienced less 90-day grade >3 Clavien-Dindo complications (33% vs 68%, P < .001), but higher 90-day mortality rate (7.0% vs 0%, P = .03). R0 resections (81% vs 82%) were similar. Overall survival, excluding 90-day postoperative deaths, was similar in both regions. DISCUSSION Despite performing more extensive resections, the low perioperative mortality rate observed in Nagoya was probably influenced by a combination of patient-, tumor-, and surgery-related factors.
Collapse
Affiliation(s)
- Núria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA.
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mario Serradilla-Martín
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain.
| | - Mar Achalandabaso
- HPB Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - François Jehaes
- HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Bobby V M Dasari
- Liver Transplant and HPB Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Sara Mambrilla-Herrero
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anita Balakrishnan
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust, and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Frederik J H Hoogwater
- HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - María J Amaral
- General Surgery, Centro Hospitalar e Universitário de Coimbra, and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Bodil Andersson
- Department of Clinical Science Lund, Surgery, Lund University and Skane University Hospital, Lund, Sweden
| | - Frederik Berrevoet
- General and HPB Surgery, and Liver Transplantation, University Hospital Gent, Gent, Belgium
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
| | - Víctor López-López
- General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Olivier Detry
- Abdominal Surgery and Transplantation, CHU Liege, University of Liege, Belgium
| | | | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Damján Pekli
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Cándido F Alcázar-López
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Horacio Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thalis Christophides
- General Surgery Department, HPB Division, Nicosia General Hospital, Nicosia, Cyprus
| | | | - David Francart
- Department of Abdominal Surgery, CHC Groupe Santé, Liège, Belgium
| | - Colin B Noel
- HPB Clinical Unit, Gastrointestinal Surgery, Universitas Academic Hospital, University of the Free State, South Africa
| | | | | | - George N Tzimas
- HPB Surgery, Department of Surgery, Hygeia Hospital, Athens, Greece
| | - Sheraz Yaqub
- HPB Surgery, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Safi Dokmak
- HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Mikel Prieto-Calvo
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
| | - Melroy A D'Souza
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Harry V M Spiers
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust, and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Marius C van den Heuvel
- HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ramón Charco
- HPB Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Mickaël Lesurtel
- HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - José M Ramia
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Miguel Hernández University, Alicante, Spain
| |
Collapse
|
|
7
|
Wang L, Ni B, Wang J, Zhou J, Wang J, Jiang J, Sui Y, Tian Y, Gao F, Lyu Y. Research Progress of Scutellaria baicalensis in the Treatment of Gastrointestinal Cancer. Integr Cancer Ther 2024; 23:15347354241302049. [PMID: 39610320 PMCID: PMC11605761 DOI: 10.1177/15347354241302049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 10/31/2024] [Accepted: 11/07/2024] [Indexed: 11/30/2024] Open
Abstract
Gastrointestinal (GI) cancer stands as one of the most prevalent forms of cancer globally, presenting a substantial medical and economic burden on cancer treatment. Despite advancements in therapies, it continues to exhibit the second highest mortality rate, primarily attributed to drug resistance and post-treatment side effects. There is an urgent need for novel therapeutic approaches to tackle this persistent challenge. Scutellaria baicalensis, widely used in Traditional Chinese Medicine (TCM), holds a profound pharmaceutical legacy. Modern pharmacological studies have unveiled its anticancer, antioxidant, and immune-enhancing properties. S. baicalensis contains hundreds of active ingredients, with flavonoids, polysaccharides, phenylethanoid glycosides, terpenoids, and sterols being the principal components. These constituents contribute to the treatment of GI cancer by inducing apoptosis in tumor cells, arresting the cell cycle, inhibiting tumor proliferation and metastasis, regulating the tumor microenvironment, modulating epigenetics, and reversing drug resistance. Furthermore, the utilization of modern drug delivery technologies can enhance the bioavailability and therapeutic efficacy of TCM. The treatment of GI cancer with S. baicalensis is characterized by its multi-component, multi-target, and multi-pathway advantages, and S. baicalensis has a broad prospect of becoming a clinical adjuvant or even the main therapy for GI cancer.
Collapse
Affiliation(s)
- Lankang Wang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Baoyi Ni
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jia Wang
- Hongqi Hospital of Mudanjiang Medical University, Mudanjiang, China
| | - Jilai Zhou
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Junyi Wang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jiakang Jiang
- The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yutong Sui
- Shenzhen Hospital of Southern Medical University, Shenzhen, China
| | - Yaoyao Tian
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Feng Gao
- Mudanjiang Hospital of Chinese Medicine, Mudanjiang, China
| | - Yufeng Lyu
- Hongqi Hospital of Mudanjiang Medical University, Mudanjiang, China
| |
Collapse
|
|
8
|
Chen J, Guan P, Sun P, Yu Q, Yuan H. No communication between the bile duct and intraductal papillary neoplasm of the bile duct on imaging. Clin Hemorheol Microcirc 2024; 88:129-134. [PMID: 38669523 DOI: 10.3233/ch-242167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
As a rare biliary tract tumor, intraductal papillary neoplasm of the bile duct (IPNB) is most common in elderly men and can progress to cholangiocarcinoma- (CCa) if left untreated. It is reported that IPNB usually communicates with the bile duct. As a result, the downstream bile ducts are imaged asymmetrically dilated. However, a case of IPNB that we report here is different. Enhanced MRI revealed a lack of connectivity with the bile duct in this case. Based on this, the purpose of this case study is to suggest that the majority of imaging doctors should widely understand the various imaging manifestations of the disease to avoid misdiagnosis. In addition, although this feature was not indicated by ultrasound in this case, given previous studies and considering the convenience and non-ionizing radiation damage of CEUS, we recommend its use as a screening method for IPNB to improve diagnostic accuracy.
Collapse
Affiliation(s)
- Jianfei Chen
- Department of Ultrasound, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Peishan Guan
- Department of Ultrasound, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Pei Sun
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Qing Yu
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Haixia Yuan
- Department of Ultrasound, Zhongshan Hospital of Fudan University, Shanghai, China
- Department of Ultrasound, Shanghai Geriatric Medical Center, Shanghai, China
| |
Collapse
|
|
9
|
Kraus M, Klang E, Soffer S, Inbar Y, Konen E, Sobeh T, Apter S. MRI features of intraductal papillary mucinous neoplasm of the bile ducts, "The myth about the cyst": A systematic review. Eur J Radiol Open 2023; 11:100515. [PMID: 37609049 PMCID: PMC10440390 DOI: 10.1016/j.ejro.2023.100515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/03/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Rationale and objectives Intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is a true pre-cancerous lesion, which shares common features with pancreatic IPMN (IPMN-P). While IPMN-P is a well described entity for which guidelines were formulated and revised, IPMN-B is a poorly described entity.We carried out a systematic review to evaluate the existing literature, emphasizing the role of MRI in IPMN-B depiction. Materials and methods PubMed database was used to identify original studies and case series that reported MR Imaging features of IPMN-B. The search keywords were "IPMN OR intraductal papillary mucinous neoplasm OR IPNB OR intraductal papillary neoplasm of the bile duct AND Biliary OR biliary cancer OR hepatic cystic lesions". Risk of bias and applicability were evaluated using the QUADAS-2 tool. Results 884 Records were Identified through database searching. 12 studies satisfied the inclusion criteria, resulting in MR features of 288 patients. All the studies were retrospective. Classic features of IPMN-B are under-described. Few studies note worrisome features, concerning for an underlying malignancy. 50 % of the studies had a high risk of bias and concerns regarding applicability. Conclusions The MRI features of IPMN-B are not well elaborated and need to be further studied. Worrisome features and guidelines regarding reporting the imaging findings should be established and published. Radiologists should be aware of IPMN-B, since malignancy diagnosis in an early stage will yield improved prognosis.
Collapse
Affiliation(s)
- Matan Kraus
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Klang
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel
- Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Yael Inbar
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Konen
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamer Sobeh
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Apter
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
|
10
|
Hirayama AB, Mello ESD, Alves VAF. INTRAHEPATIC BILIARY PROLIFERATIONS: HISTOPATHOLOGY AND POTENTIAL IMMUNOHISTOCHEMICAL MARKERS. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:393-403. [PMID: 37792770 DOI: 10.1590/s0004-2803.23032023-107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 10/06/2023]
Abstract
•Intrahepatic biliary proliferations represent a spectrum varying from reactive to malignant entities. •Clinical and imaging patterns may be similar, requiring histopathological and immunohistochemistry for precise diagnosis. Intrahepatic biliary proliferations represent a spectrum from reactive (ductular reaction, some with atypical architecture), hamartomatous (von Meyenburg complex), benign (bile duct adenoma) and precursor/borderline entities (biliary intraepithelial neoplasia, intraductal papillary neoplasm of the bile duct) to fully malignant (cholangiocarcinoma) neoplasms. Clinical pictures and even imaging patterns may be similar, requiring refined studies aiming at histopathological and immunohistochemistry for more precise diagnosis, essential for correct patient management. This article discusses updated concepts and definitions of most relevant entities aiming more specifically at the differential diagnosis in practice, focusing on morphology and immunohistochemistry, with a discussion of potential markers to help distinguishing between benign and malignant lesions.
Collapse
Affiliation(s)
- André Bubna Hirayama
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
- CICAP - Anatomia Patológica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - Evandro Sobroza de Mello
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
- CICAP - Anatomia Patológica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - Venâncio Avancini Ferreira Alves
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
- CICAP - Anatomia Patológica, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| |
Collapse
|
|
11
|
Lluís N, Serradilla-Martín M, Achalandabaso M, Jehaes F, Dasari BV, Mambrilla-Herrero S, Sparrelid E, Balakrishnan A, Hoogwater FJ, Amaral MJ, Andersson B, Berrevoet F, Doussot A, López-López V, Alsammani M, Detry O, Domingo-del Pozo C, Machairas N, Pekli D, Alcázar-López CF, Asbun H, Björnsson B, Christophides T, Díez-Caballero A, Francart D, Noel CB, Sousa-Silva D, Toledo-Martínez E, Tzimas GN, Yaqub S, Cauchy F, Prieto-Calvo M, D’Souza MA, Spiers HV, van den Heuvel MC, Charco R, Lesurtel M, Ramia JM. Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study). Int J Surg 2023; 109:760-771. [PMID: 36917142 PMCID: PMC10389541 DOI: 10.1097/js9.0000000000000280] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/19/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND/PURPOSE Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease in Western countries. The main aim of this study was to characterize current surgical strategies and outcomes in the mainly European participating centers. METHODS A multi-institutional retrospective series of patients with a diagnosis of IPNB undergoing surgery between 1 January 2010 and 31 December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association. The textbook outcome (TO) was defined as a non-prolonged length of hospital stay plus the absence of any Clavien-Dindo grade at least III complications, readmission, or mortality within 90 postoperative days. RESULTS A total of 28 centers contributed 85 patients who underwent surgery for IPNB. The median age was 66 years (55-72), 49.4% were women, and 87.1% were Caucasian. Open surgery was performed in 72 patients (84.7%) and laparoscopic in 13 (15.3%). TO was achieved in 54.1% of patients, reaching 63.8% after liver resection and 32.0% after pancreas resection. Median overall survival was 5.72 years, with 5-year overall survival of 63% (95% CI: 50-82). Overall survival was better in patients with Charlson comorbidity score 4 or less versus more than 4 ( P =0.016), intrahepatic versus extrahepatic tumor ( P =0.027), single versus multiple tumors ( P =0.007), those who underwent hepatic versus pancreatic resection ( P =0.017), or achieved versus failed TO ( P =0.029). Multivariable Cox regression analysis showed that not achieving TO (HR: 4.20; 95% CI: 1.11-15.94; P =0.03) was an independent prognostic factor of poor overall survival. CONCLUSIONS Patients undergoing liver resection for IPNB were more likely to achieve a TO outcome than those requiring a pancreatic resection. Comorbidity, tumor location, and tumor multiplicity influenced overall survival. TO was an independent prognostic factor of overall survival.
Collapse
Affiliation(s)
- Núria Lluís
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Mario Serradilla-Martín
- Department of Surgery, Instituto de Investigación Sanitaria Aragón, Miguel Servet University Hospital, Zaragoza
| | - Mar Achalandabaso
- HPB Surgery and Transplantation, Hospital Universitario Vall d’Hebron
| | - François Jehaes
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Bobby V.M. Dasari
- Liver Transplant and HPB Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Ernesto Sparrelid
- Department of Clinical Science, Division of Surgery, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Anita Balakrishnan
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust
- Department of Surgery, University of Cambridge, Cambridge
| | - Frederik J.H. Hoogwater
- Department of HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria J. Amaral
- Department of General Surgery, Centro Hospitalar e Universitário de Coimbra
- Faculty of Medicine, University of Coimbra, Coimbra
| | - Bodil Andersson
- Department of Surgery, Lund University
- Skane University Hospital, Lund
| | - Frederik Berrevoet
- Department of General and HPB Surgery, and Liver Transplantation, University Hospital Gent, Gent
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, Besancon
| | - Víctor López-López
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de La Arrixaca, IMIB-ARRIXACA, Murcia
| | | | - Olivier Detry
- Department of Abdominal Surgery and Transplantation, CHU Liege, University of Liege
| | | | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens
| | - Damján Pekli
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Cándido F. Alcázar-López
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL)
| | - Horacio Asbun
- Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, Florida, USA
| | - Bergthor Björnsson
- Department of Surgery in Linköping and Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thalis Christophides
- General Surgery Department, HPB Division, Nicosia General Hospital, Nicosia, Cyprus
| | | | - David Francart
- Department of Abdominal Surgery, CHC Groupe Santé, Liège, Belgium
| | - Colin B. Noel
- HPB Clinical Unit, Gastrointestinal Surgery, Universitas Academic Hospital, University of the Free State, Bloemfontein
| | - Donzília Sousa-Silva
- Department of Surgery, HEBIPA – Hepatobiliary and Pancreatic Unit, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Enrique Toledo-Martínez
- Servicio de Cirugía, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - George N. Tzimas
- Hepatobiliary Surgery Department, Hygeia Hospital, Athens, Greece
| | - Sheraz Yaqub
- Department of HPB Surgery, Oslo University Hospital
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - François Cauchy
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - Mikel Prieto-Calvo
- Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao
| | - Melroy A. D’Souza
- Department of Clinical Science, Division of Surgery, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm
| | - Harry V.M. Spiers
- Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust
- Department of Surgery, University of Cambridge, Cambridge
| | - Marius C. van den Heuvel
- Department of HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ramón Charco
- HPB Surgery and Transplantation, Hospital Universitario Vall d’Hebron
| | - Mickaël Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
| | - José M. Ramia
- HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL)
- Miguel Hernández University, Alicante
| |
Collapse
|
|
12
|
Chatterjee A, Mukhopadhyay S, Ghosh P, Shah D, Gehani A, Baheti A, Gupta B, Chandra A, Chaturvedi AK, Khoda J, Patra A, Lingegowda D, Sen S. Imaging Recommendations for Diagnosis, Staging, and Management of Hepatic and Biliary Tract Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1760320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
AbstractMajor hepatobiliary cancers include hepatocellular carcinoma, gallbladder carcinoma, and cholangiocarcinoma. There are multiple guidelines and recommendations for the imaging evaluation of these cancers. This article reviews and summarizes principles and recommendations of imaging in hepatobiliary cancers. The cross-sectional imaging protocol is similar among these lesions and is discussed at first followed by the separate discussion of each cancer.
Collapse
Affiliation(s)
- Argha Chatterjee
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Sumit Mukhopadhyay
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Priya Ghosh
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Diva Shah
- Department of Radiology, HCG Cancer Centre, Ahmedabad, Gujarat, India
| | - Anisha Gehani
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Akshay Baheti
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Gupta
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Aditi Chandra
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Arvind K. Chaturvedi
- Department of Radiology and Interventional Oncology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
| | - Jeevitesh Khoda
- Department of Radiology, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, India
| | - Anurima Patra
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Dayananda Lingegowda
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| | - Saugata Sen
- Department of Radiology and Imaging Sciences, Tata Medical Center, Kolkata, West Bengal, India
| |
Collapse
|
|
13
|
Granata V, Fusco R, De Muzio F, Cutolo C, Grassi F, Brunese MC, Simonetti I, Catalano O, Gabelloni M, Pradella S, Danti G, Flammia F, Borgheresi A, Agostini A, Bruno F, Palumbo P, Ottaiano A, Izzo F, Giovagnoni A, Barile A, Gandolfo N, Miele V. Risk Assessment and Cholangiocarcinoma: Diagnostic Management and Artificial Intelligence. BIOLOGY 2023; 12:213. [PMID: 36829492 PMCID: PMC9952965 DOI: 10.3390/biology12020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver tumor, with a median survival of only 13 months. Surgical resection remains the only curative therapy; however, at first detection, only one-third of patients are at an early enough stage for this approach to be effective, thus rendering early diagnosis as an efficient approach to improving survival. Therefore, the identification of higher-risk patients, whose risk is correlated with genetic and pre-cancerous conditions, and the employment of non-invasive-screening modalities would be appropriate. For several at-risk patients, such as those suffering from primary sclerosing cholangitis or fibropolycystic liver disease, the use of periodic (6-12 months) imaging of the liver by ultrasound (US), magnetic Resonance Imaging (MRI)/cholangiopancreatography (MRCP), or computed tomography (CT) in association with serum CA19-9 measurement has been proposed. For liver cirrhosis patients, it has been proposed that at-risk iCCA patients are monitored in a similar fashion to at-risk HCC patients. The possibility of using Artificial Intelligence models to evaluate higher-risk patients could favor the diagnosis of these entities, although more data are needed to support the practical utility of these applications in the field of screening. For these reasons, it would be appropriate to develop screening programs in the research protocols setting. In fact, the success of these programs reauires patient compliance and multidisciplinary cooperation.
Collapse
Affiliation(s)
- Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Federica De Muzio
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, University of Molise, 86100 Campobasso, Italy
| | - Carmen Cutolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy
| | - Francesca Grassi
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy
| | - Maria Chiara Brunese
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, University of Molise, 86100 Campobasso, Italy
| | - Igino Simonetti
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, Via Cornelia dei Gracchi 65, 80126 Naples, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56216 Pisa, Italy
| | - Silvia Pradella
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Ginevra Danti
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Federica Flammia
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Federico Bruno
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio 1, 67100 L’Aquila, Italy
| | - Pierpaolo Palumbo
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio 1, 67100 L’Aquila, Italy
| | - Alessandro Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Istituto Nazionale Tumori IRCCS-Fondazione G. Pascale, 80130 Naples, Italy
| | - Francesco Izzo
- Division of Epatobiliary Surgical Oncology, Istituto Nazionale Tumori IRCCS Fondazione Pascale—IRCCS di Napoli, 80131 Naples, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, Via Conca 71, 60126 Ancona, Italy
| | - Antonio Barile
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, Via Vetoio 1, 67100 L’Aquila, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, 16149 Genoa, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy
| |
Collapse
|
|
14
|
Chen WJ, Wolff E, Varma CR, Shoela R. Biliary Intraepithelial Neoplasia With Gallbladder Adenoma and Cirrhosis: A Case Report. Cureus 2022; 14:e27780. [PMID: 36106242 PMCID: PMC9449331 DOI: 10.7759/cureus.27780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/17/2022] Open
Abstract
Biliary intraepithelial neoplasia (BilIN) is a precursor lesion of cholangiocarcinoma that has been rarely reported. The present study reports a 56-year-old male with low-grade BilIN of the bile ducts and the cystic duct margin. Stent exchange endoscopy demonstrated an irregular, intraductal mass extending along the common bile duct, common hepatic duct, and hepatic duct bifurcation. The peribiliary mass was found to abut the right portal vein, inferior vena cava, and pancreatic head, and replaced the right hepatic artery. In addition, there was evidence of gallbladder adenoma managed with cholecystectomy and a right-lobed liver lesion and cirrhosis, which prompted the discussion of prophylactic liver transplantation. We emphasize the radiological features of BilIN and associated pathological findings through multiple imaging modalities. Consideration of this diagnosis is indicated in western countries and requires timely management based on available guidelines.
Collapse
|
|
15
|
Pandey S, Agarwal N, Gupta V, Sharma A, Aggarwal A, Gupta S, Krishan R. Diagnosing rare intraductal biliary neoplasms – Intraductal papillary neoplasm of the bile duct: A case report with typical imaging findings. SA J Radiol 2022; 26:2387. [PMID: 35548709 PMCID: PMC9082281 DOI: 10.4102/sajr.v26i1.2387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
Intraductal papillary neoplasm of the bile duct (IPN-B) is a rare preinvasive intraductal pathology of the biliary tract. It should be differentiated from other more common benign or malignant causes of biliary obstruction and dilatation such as calculi or cholangiocarcinoma because the management and prognosis of this condition differs significantly. This case report describes a case of IPN-B in a 45-year-old female patient who presented with non-specific complaints of chronic abdominal pain without jaundice for three months.
Collapse
Affiliation(s)
- Saumya Pandey
- Department of Radiodiagnosis, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Nitin Agarwal
- Department of Radiodiagnosis, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Vidushi Gupta
- Department of Radiodiagnosis, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Ashok Sharma
- Department of Radiodiagnosis, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Anil Aggarwal
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Sunita Gupta
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| | - Ram Krishan
- Department of Pathology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi University, New Delhi, India
| |
Collapse
|
|
16
|
Vij M, Puri Y, Rammohan A, G G, Rajalingam R, Kaliamoorthy I, Rela M. Pathological, molecular, and clinical characteristics of cholangiocarcinoma: A comprehensive review. World J Gastrointest Oncol 2022; 14:607-627. [PMID: 35321284 PMCID: PMC8919011 DOI: 10.4251/wjgo.v14.i3.607] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/13/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Cholangiocarcinomas are a heterogeneous group of highly aggressive cancers that may arise anywhere within the biliary tree. There is a wide geographical variation with regards to its incidence, and risk-factor associations which may include liver fluke infection, primary sclerosing cholangitis, and hepatolithiasis amongst others. These tumours are classified into intrahepatic, perihilar and distal based on their anatomical location. Morphologically, intrahepatic cholangiocarcinomas are further sub-classified into small and large duct variants. Perihilar and distal cholangiocarcinomas are usually mucin-producing tubular adenocarcinomas. Cholangiocarcinomas develop through a multistep carcinogenesis and are preceded by dysplastic and in situ lesions. While clinical characteristics and management of these tumours have been extensively elucidated in literature, their ultra-structure and tumour biology remain relatively unknown. This review focuses on the current knowledge of pathological characteristics, molecular alterations of cholangiocarcinoma, and its precursor lesions (including biliary intraepithelial neoplasia, intraductal papillary neoplasms of the bile duct, intraductal tubulopapillary neoplasms and mucinous cystic neoplasm).
Collapse
Affiliation(s)
- Mukul Vij
- Department of Pathology, Dr Rela Institute and Medical center, Chennai 600044, Tamil Nadu, India
| | - Yogesh Puri
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Center, Chennai 600044, Tamil Nadu, India
| | - Ashwin Rammohan
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Center, Chennai 600044, Tamil Nadu, India
| | - Gowripriya G
- Department of Pathology, Dr Rela Institute and Medical center, Chennai 600044, Tamil Nadu, India
| | - Rajesh Rajalingam
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Center, Chennai 600044, Tamil Nadu, India
| | - Ilankumaran Kaliamoorthy
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Center, Chennai 600044, Tamil Nadu, India
| | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Center, Chennai 600044, Tamil Nadu, India
| |
Collapse
|
|
17
|
Wei PK, Gupta M, Tsai LL, Lee KS, Jaramillo AM, Smith MP, LeGout JD, Shenoy-Bhangle AS. Spectrum of MRI Features of Mucin-producing Neoplasms in the Abdomen and Pelvis. Radiographics 2022; 42:469-486. [PMID: 35061517 DOI: 10.1148/rg.210055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Mucin-producing neoplasms in the abdomen and pelvis are a distinct entity, separate from simple fluid-containing neoplasms and loculated fluid collections. Mucin is a thick gelatinous substance and-owing to its high water content-has imaging features that can be mistaken for those of simple fluid-containing neoplasms with multiple imaging modalities. However, mucin-producing neoplasms arise from specific organs in the abdomen and pelvis, with unique imaging appearances, knowledge of which is important to guide accurate diagnosis and management. With its large field of view and high soft-tissue resolution, MRI has advantages over other imaging modalities in characterizing these neoplasms. The authors focus on the spectrum of MRI features of such mucin-producing neoplasms and illustrate how-despite a varied organ origin-some of these neoplasms share similar MRI and histopathologic features, thereby helping narrow the differential diagnosis. One common finding in these tumors is that the presence of internal complexity and solid enhancing components increases as the degree of malignant transformation increases. Lack of internal complexity generally indicates benignity. These tumors have a varied range of prognosis; for example, a low-grade appendiceal mucinous neoplasm is indicative of a good prognosis, while a mucinous tumor of the rectum is known to manifest at an early age with aggressive behavior and poorer prognosis compared with its nonmucinous counterpart. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Pei-Kang Wei
- From the Departments of Radiology (P.K.W., L.L.T., K.S.L., M.P.S., A.S.S.B.) and Pathology (M.G.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.M.J.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (J.D.L.)
| | - Mamta Gupta
- From the Departments of Radiology (P.K.W., L.L.T., K.S.L., M.P.S., A.S.S.B.) and Pathology (M.G.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.M.J.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (J.D.L.)
| | - Leo L Tsai
- From the Departments of Radiology (P.K.W., L.L.T., K.S.L., M.P.S., A.S.S.B.) and Pathology (M.G.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.M.J.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (J.D.L.)
| | - Karen S Lee
- From the Departments of Radiology (P.K.W., L.L.T., K.S.L., M.P.S., A.S.S.B.) and Pathology (M.G.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.M.J.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (J.D.L.)
| | - Adrian M Jaramillo
- From the Departments of Radiology (P.K.W., L.L.T., K.S.L., M.P.S., A.S.S.B.) and Pathology (M.G.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.M.J.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (J.D.L.)
| | - Martin P Smith
- From the Departments of Radiology (P.K.W., L.L.T., K.S.L., M.P.S., A.S.S.B.) and Pathology (M.G.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.M.J.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (J.D.L.)
| | - Jordan D LeGout
- From the Departments of Radiology (P.K.W., L.L.T., K.S.L., M.P.S., A.S.S.B.) and Pathology (M.G.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.M.J.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (J.D.L.)
| | - Anuradha S Shenoy-Bhangle
- From the Departments of Radiology (P.K.W., L.L.T., K.S.L., M.P.S., A.S.S.B.) and Pathology (M.G.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.M.J.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (J.D.L.)
| |
Collapse
|
|
18
|
Desjonqueres E, Campani C, Marra F, Zucman-Rossi J, Nault JC. Preneoplastic lesions in the liver: Molecular insights and relevance for clinical practice. Liver Int 2022; 42:492-506. [PMID: 34982503 DOI: 10.1111/liv.15152] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) are the most frequent primary liver cancers, accounting for approximately 80% and 15%, respectively. HCC carcinogenesis occurs mostly in cirrhosis and is a complex multi-step process, from precancerous lesions (low-grade and high-grade dysplastic nodules) to progressed HCC. During the different stages of liver carcinogenesis, there is an accumulation of pathological, genetic and epigenetic changes leading to initiation, malignant transformation and finally tumour progression. In contrast, a small subset of HCC occurs in normal liver from the transformation of hepatocellular adenoma (HCA), a benign hepatocellular tumour. The recent molecular classification enables to stratify HCAs according to their risk of complication, in particular malignant transformation, associated with mutations in exon 3 of the catenin beta 1 (CTNNB1) gene. Cholangiocarcinoma (CCA) derives from the multistep malignant transformation of preneoplastic lesions, like biliary intraepithelial neoplasia (BilIN) and intraductal papillary neoplasm of the bile duct (IPNB), for which a pre-operative diagnosis remains difficult. Different genetic alterations are involved in BilIN and IPNB progression, leading to the development of tubular or intestinal adenocarcinoma. The aims of this review are to describe the main clinical and molecular features of preneoplastic lesions leading to the development of HCC and CCA, their implications in clinical practice and the perspectives for future research.
Collapse
Affiliation(s)
- Elvire Desjonqueres
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, team « Functional Genomics of Solid Tumors », Paris, France.,Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
| | - Claudia Campani
- Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, team « Functional Genomics of Solid Tumors », Paris, France.,Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Jessica Zucman-Rossi
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, team « Functional Genomics of Solid Tumors », Paris, France.,Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France.,Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Jean-Charles Nault
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France.,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, team « Functional Genomics of Solid Tumors », Paris, France.,Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France
| |
Collapse
|
|
19
|
Ma L, Jiang Y, Wu N. Long non-coding RNA CCL2 promoted gastric cancer function via miR-128/ PARP2 signal pathway. Bioengineered 2022; 13:1602-1611. [PMID: 35000531 PMCID: PMC8805977 DOI: 10.1080/21655979.2021.2020548] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/02/2021] [Indexed: 12/26/2022] Open
Abstract
Amounts of studies have revealed long non-coding RNA (lncRNA) was related to the development of gastric cancer. Here, our results suggested the function and regulatory mechanism of CCL2 in gastric cancer. Quantitative polymerase-chain reaction (qPCR) was employed to inspect lncRNA CCL2 and miR-128 expression in normal gastric cell line (GES-1) and tumor cell lines (HGC-27 and MKN-45). The effects of CCL2 and miR-128 were measured via Luciferase reporter test. Western blot was used to check PARP2 protein expression. CCL2 expression and PARP2 protein levels were up-regulated, while miR-128 expression was obviously lower. Meanwhile, CCL2 down-regulating significantly repressed the proliferation, migration, and invasion by regulating miR-128. In addition, we proved miR-128 was a direct target of CCL2 through double luciferase assay and bioinformatics analysis. Moreover, miR-128 markedly inhibited the proliferation, migration, and invasion in gastric cancer. More importantly, miR-128 could reverse the effects of lncRNA CCL2 knocked down. PARP2-si obviously suppressed in gastric cancer proliferation, migration, and invasion. Meanwhile, miR-128 mimic and the knockout of CCL2 distinctly decreased PARP2 protein level. Additionally, luciferase report experiments certificated that PARP2 targeted miR-128, implying PARP2 directly interacted with miR-128 in gastric cancer. More interestingly, the downregulation of PARP could reverse the trend triggered by miR-128 inhibitor in gastric tumor. All over these results showed lncRNA CCL2 played importance of role in gastric tumor via miR-128/PARP2 axis signal pathway. LncRNA CCL2 accelerated gastric cancer progression by regulating miR-128/PARP2 signaling pathway, providing a novel possible strategy for the treatment of gastric cancer.
Collapse
Affiliation(s)
- Liang Ma
- Department of Digestive Internal Medicine,Shaoxing No. 2 Hospital Medical Community General Hospital,Shaoxing, Zhejiang Province, China
| | - Yunshan Jiang
- Department of Oncology, Longyan First Hospital, Affiliated to Fujian Medical University,Longyan, P.R. China
| | - Ning Wu
- Department of Oncology, Shanghai Pudong New Area Gongli Hospital, Shanghai, P.R. China
| |
Collapse
|
|
20
|
Recent Advances in Implantation-Based Genetic Modeling of Biliary Carcinogenesis in Mice. Cancers (Basel) 2021; 13:cancers13102292. [PMID: 34064809 PMCID: PMC8151177 DOI: 10.3390/cancers13102292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Biliary tract cancer (BTC) is often refractory to conventional therapeutics and is difficult to diagnose in the early stages. In addition, the pathogenesis of BTC is not fully understood, despite recent advances in cancer genome analysis. To address these issues, the development of fine disease models is critical for BTC. Although still limited in number, there are various platforms for genetic models of BTC owing to newly emerging technology. Among these, implantation-based models have recently drawn attention for their convenience, flexibility, and scalability. To highlight the relevance of this approach, we comprehensively summarize the advantages and disadvantages of BTC models developed using diverse approaches. Currently available research data on intra- and extrahepatic cholangiocarcinoma and gallbladder carcinoma are presented in this review. This information will likely help in selecting the optimal models for various applications and develop novel innovative models based on these technologies. Abstract Epithelial cells in the biliary system can develop refractory types of cancers, which are often associated with inflammation caused by viruses, parasites, stones, and chemicals. Genomic studies have revealed recurrent genetic changes and deregulated signaling pathways in biliary tract cancer (BTC). The causal roles have been at least partly clarified using various genetically engineered mice. Technical advances in Cre-LoxP technology, together with hydrodynamic tail injection, CRISPR/Cas9 technology, in vivo electroporation, and organoid culture have enabled more precise modeling of BTC. Organoid-based genetic modeling, combined with implantation in mice, has recently drawn attention as a means to accelerate the development of BTC models. Although each model may not perfectly mimic the disease, they can complement one another, or two different approaches can be integrated to establish a novel model. In addition, a comparison of the outcomes among these models with the same genotype provides mechanistic insights into the interplay between genetic alterations and the microenvironment in the pathogenesis of BTCs. Here, we review the current status of genetic models of BTCs in mice to provide information that facilitates the wise selection of models and to inform the future development of ideal disease models.
Collapse
|
|
21
|
Lee JH, Kim HS, Park JH, Park JS. Intraductal papillary mucinous neoplasm of the biliary tract with cardiac metastasis: A case report. Medicine (Baltimore) 2021; 100:e24310. [PMID: 33546060 PMCID: PMC7837973 DOI: 10.1097/md.0000000000024310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/24/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Intraductal papillary mucinous neoplasm of the biliary tract (IPNB) is a rare, low-grade neoplasm limited to the bile duct mucosa. The malignant transformation rate is low, and there have been limited reports of metastasis to other organs. Herein, we presented a rare case of a patient who was diagnosed with IPNB concurrent with invasive adenocarcinoma after surgery and was diagnosed with cardiac metastasis 6 months later. PATIENT CONCERNS A 61-year-old male patient presented with abdominal pain to a local clinic. He was diagnosed with intrahepatic cholangiocarcinoma with pancreatitis and transferred to our hospital. DIAGNOSIS Diagnostic testing (magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, positron emission tomography-computed tomography) revealed a papillary neoplasm and invasive adenocarcinoma with papillary neoplasm in the periampullary lesion. INTERVENTIONS Pancreaticoduodenectomy, right hemihepatectomy, and left lateral sectionectomy of the liver were performed. After surgery, we planned gemcitabine-based adjuvant chemotherapy. OUTCOMES Upon completion of the sixth gemcitabine chemotherapy cycle, a hyperechoic, oval-shaped mass (1.3 × 2.6 cm) was found on the outer wall of the right atrium. Resection of a cardiac tumor in the right atrium and patch repair were performed. CONCLUSION To our knowledge, no other case of cardiac metastasis found during observation after surgery for an IPNB has been described. IPNBs are known to be less aggressive and to have a lower metastasis rate than intraductal papillary mucinous neoplasms; therefore, the number of case reports describing metastasis after surgery is relatively low. Our case suggests that close observation is necessary in patients diagnosed with an IPNB.
Collapse
Affiliation(s)
- Joo Hyung Lee
- Pancreatobiliary Cancer Clinic, Department of Surgery
| | - Hyung Sun Kim
- Pancreatobiliary Cancer Clinic, Department of Surgery
| | - Ji Hyun Park
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | | |
Collapse
|
|
22
|
Dolz Abadía C. Premalignant lesions of the extrahepatic biliary tract. A territory to be explored hand in hand with cholangioscopy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:4-6. [PMID: 33258378 DOI: 10.17235/reed.2020.7589/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The biliary mucosa, both intrahepatic and extrahepatic, is lined by a single layer of columnar cells with oval nuclei near the base and a slightly eosinophilic cytoplasm. Although normal biliary ducts have no goblet cells, there are periductal mucous glands lined by mucus-producing cuboidal cells, with mucin from these glands draining to the lumen of bile ducts.
Collapse
|
|
23
|
Shin D, Lee S, Lee JH, Hong SM, Park SY, Yoo C, Lee W, Song KB, Hwang DW, Kim SC. Prognostic implication of high grade biliary intraepithelial neoplasia in bile duct resection margins in patients with resected perihilar cholangiocarcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:604-613. [PMID: 32639085 DOI: 10.1002/jhbp.800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND In surgery for perihilar cholangiocarcinoma (PHCC), it is still controversial as to whether additional resection of the bile duct is needed on high grade (HG) biliary intraepithelial neoplasia (BilIN) margin. METHODS Patients who underwent surgery for PHCC with curative intent between 2001 and 2015 were stratified by resection margin, and were analyzed comparing the clinical outcomes. RESULTS Of the 306 study participants, 217 patients had negative margins (R0), 18 patients had HG BilIN, and 71 patients had positive margins (R1). The median overall survival was 36.0 months in the R0 group, 41.0 months in the HG BilIN group, and 25.0 months in the R1 group while overall survival rates at 5 years were 34.5% in the R0 group, 44.4% in the HG BilIN group, and 21.0% in the R1 group. The median disease-free survival was 15.0 months in the R0 group, 16.5 months in the HG BilIN group, and 12.0 months in the R1 group. CONCLUSIONS Although the HG BilIN group had neoplasia with malignant potential, survival and recurrence outcomes were comparable to those of the R0 group, which suggests that no additional resection is needed when the maximal bile duct margin in PHCC surgery contains HG BilIN.
Collapse
Affiliation(s)
- Dakyum Shin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sojung Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seo Young Park
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woohyung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
|
24
|
Lopens S, Krawczyk M, Papp M, Milkiewicz P, Schierack P, Liu Y, Wunsch E, Conrad K, Roggenbuck D. The search for the Holy Grail: autoantigenic targets in primary sclerosing cholangitis associated with disease phenotype and neoplasia. AUTO- IMMUNITY HIGHLIGHTS 2020; 11:6. [PMID: 32178720 PMCID: PMC7077156 DOI: 10.1186/s13317-020-00129-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/06/2020] [Indexed: 12/22/2022]
Abstract
Unlike in other autoimmune liver diseases such as autoimmune hepatitis and primary biliary cholangitis, the role and nature of autoantigenic targets in primary sclerosing cholangitis (PSC), a progressive, chronic, immune-mediated, life threatening, genetically predisposed, cholestatic liver illness, is poorly elucidated. Although anti-neutrophil cytoplasmic antibodies (ANCA) have been associated with the occurrence of PSC, their corresponding targets have not yet been identified entirely. Genome-wide association studies revealed a significant number of immune-related and even disease-modifying susceptibility loci for PSC. However, these loci did not allow discerning a clear autoimmune pattern nor do the therapy options and the male gender preponderance in PSC support a pathogenic role of autoimmune responses. Nevertheless, PSC is characterized by the co-occurrence of inflammatory bowel diseases (IBD) demonstrating autoimmune responses. The identification of novel autoantigenic targets in IBD such as the major zymogen granule membrane glycoprotein 2 (GP2) or the appearance of proteinase 3 (PR3) autoantibodies (autoAbs) have refocused the interest on a putative association of loss of tolerance with the IBD phenotype and consequently with the PSC phenotype. Not surprisingly, the report of an association between GP2 IgA autoAbs and disease severity in patients with PSC gave a new impetus to autoAb research for autoimmune liver diseases. It might usher in a new era of serological research in this field. The mucosal loss of tolerance against the microbiota-sensing GP2 modulating innate and adaptive intestinal immunity and its putative role in the pathogenesis of PSC will be elaborated in this review. Furthermore, other potential PSC-related autoantigenic targets such as the neutrophil PR3 will be discussed. GP2 IgA may represent a group of new pathogenic antibodies, which share characteristics of both type 2 and 3 of antibody-mediated hypersensitive reactions according to Coombs and Gell.
Collapse
Affiliation(s)
| | - Marcin Krawczyk
- Department of Medicine II, Saarland University Hospital, Saarland University, Homburg/Saar, Germany
- Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland
| | - Maria Papp
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Piotr Milkiewicz
- Liver and Internal Medicine Unit, Medical University of Warsaw, Warsaw, Poland
| | - Peter Schierack
- Institute of Biotechnology, Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Yudong Liu
- Department of Laboratory Medicine, Peking University People's Hospital, Beijing, China
| | - Ewa Wunsch
- Translational Medicine Group, Pomeranian Medical University, Szczecin, Poland
| | - Karsten Conrad
- Institute of Immunology, Technical University Dresden, Dresden, Germany
| | - Dirk Roggenbuck
- Institute of Biotechnology, Faculty Environment and Natural Sciences, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany.
- Faculty of Health Sciences, Joint Faculty of the Brandenburg University of Technology Cottbus-Senftenberg, the Brandenburg Medical School Theodor Fontane and the University of Potsdam, Universitätsplatz 1, 01968, Senftenberg, Germany.
| |
Collapse
|
|
25
|
Geramizadeh B. Precursor Lesions of Cholangiocarcinoma: A Clinicopathologic Review. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2020; 13:2632010X20925045. [PMID: 32596664 PMCID: PMC7297471 DOI: 10.1177/2632010x20925045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/18/2020] [Indexed: 12/12/2022]
Abstract
Cholangiocarcinoma (CCA) develops through multistep carcinogenesis. During the past decades, 2 precursors have been proved to evolve to CCA. The 2 main precursor lesions of CCA are biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile duct. It is an interesting and relatively novel entity for the hepatobiliary surgeons, radiologists, oncologists, and pathologists. It worth being familiar with these 2 entities for better communication between pathologists, oncologists, and surgeons to improve the treatment and follow-up of these lesions, which can definitely decrease their evolvement to CCA as an aggressive, poor prognostic, and life-threatening cancer. In this narrative review, I collected and discussed all published studies about these 2 precursor lesions of CCA including radiologic, clinical, and pathological manifestation.
Collapse
Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
|
26
|
Abstract
Cancers of the biliary tract include intra- and extrahepatic cholangiocarcinomas and gallbladder cancer. Biliary tract cancers are diseases with unfavorable prognoses. In recent years, several lesions have been described as precursors that precede biliary cancers. They include flat and microscopic lesions known as biliary intraepithelial neoplasia, macroscopic and tumor-forming intraductal papillary biliary neoplasia, intraductal tubular neoplasia, and mucinous cystic neoplasm of the bile duct. These conditions are rarely diagnosed, while their natural history and progression to cancer have yet to be adequately characterized. This review examines the epidemiology, pathology, molecular biology, diagnosis, and therapy of these various precursors. Further research is required if we are to better understand this evolving field and improve the prevention and early detection of bile duct cancer.
Collapse
|
|
27
|
Yoshida N, Aoyagi T, Kimura Y, Naito Y, Izuwa A, Mizoguchi K, Ishii K, Tanaka Y, Ohnishi E, Miura S, Shimamura S, Shirahama N, Kaneshiro K, Saruwatari A, Iwanaga A, Sadakari Y, Hirokata G, Ogata T, Taniguchi M. A rare case of symptomatic grossly-visible biliary intraepithelial neoplasia mimicking cholangiocarcinoma. World J Surg Oncol 2019; 17:191. [PMID: 31711502 PMCID: PMC6849222 DOI: 10.1186/s12957-019-1737-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 10/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background Biliary intraepithelial neoplasia (BilIN) is often distinguished by what it is not: the precancerous lesions are not mass-forming, are not the cause of bile duct obstruction, and are small enough (less than 5 mm long) to evade detection by the naked eye. Here, we describe an atypical case of BilIN resembling cholangiocarcinoma (CC) that was large enough to be identified by diagnostic imaging and presented with obstructive jaundice caused by a hematoma in the common bile duct (CBD). Case presentation A 64-year-old man presented to our hospital with upper abdominal pain and anorexia. Initial laboratory examinations revealed increased total bilirubin and a computed tomography (CT) scan revealed a dilated CBD. Gastroenterologists performed an endoscopic sphincterotomy (EST), which revealed that the cause of obstructive jaundice was a hematoma in the CBD. Enhanced CT scan and magnetic resonance cholangiopancreatography (MRCP) performed after the hematoma was drained showed improved dilation of the CBD and an enhanced wall thickness of bile duct measuring 25 × 10 mm at the union of the cystic and common hepatic ducts. A cholangioscope detected an elevated tumor covered by sludge in the CBD, and we performed an extrahepatic bile duct resection and cholecystectomy. The postoperative course was uneventful and the pathological examination of the resected tumor revealed that although the ulcerated lesion had inflammatory granulation tissue, it did not contain the components of invasive carcinoma. Many consecutive intraepithelial micropapillary lesions spread around the ulcerated lesion, and the epithelial cells showed an increased nucleus-to-cytoplasm ratio, nuclear hyperchromasia, and architectural atypia. The pathological diagnosis was BilIN-1 to -2. Immunohistochemical staining showed that S100P was slightly expressed and MUC5AC was positive, while MUC1 was negative and p53 was not overexpressed. Conclusion We experienced an atypical case of BilIN mimicking CC that presented with obstructive jaundice caused by a hematoma in the CBD. Our case suggested that the occurrence of BilIN can be triggered by factors other than inflammation, and can grow to a size large enough to be detected by image analyses.
Collapse
Affiliation(s)
- Naohiro Yoshida
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan.
| | - Takeshi Aoyagi
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Yoshizo Kimura
- Department of Pathology and Cytology, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Yoshiki Naito
- Department of Pathology, Kurume University School of Medicine, Asahi-machi 67, Kurume-shi, Fukuoka, 8300011, Japan
| | - Aya Izuwa
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Kimihisa Mizoguchi
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Kota Ishii
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Yu Tanaka
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Emi Ohnishi
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Shun Miura
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Satoshi Shimamura
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Nobuhisa Shirahama
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Kazuhisa Kaneshiro
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Akihiro Saruwatari
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Ayako Iwanaga
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Yoshihiko Sadakari
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Gentaro Hirokata
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Toshiro Ogata
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| | - Masahiko Taniguchi
- Department of Surgery, St. Mary's Hospital, Tsubukuhon-machi 422, Kurume-shi, Fukuoka, 8308543, Japan
| |
Collapse
|
|
28
|
Maeda T, Ebata T, Yokoyama Y, Igami T, Mizuno T, Yamaguchi J, Onoe S, Watanabe N, Nagino M. A case of small in situ perihilar cholangiocarcinoma incidentally accompanied by benign bile duct stricture after open cholecystectomy. Surg Case Rep 2019; 5:177. [PMID: 31707480 PMCID: PMC6842380 DOI: 10.1186/s40792-019-0745-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/31/2019] [Indexed: 11/19/2022] Open
Abstract
Background In situ cholangiocarcinoma is difficult to detect by imaging studies. Thus, cholangiocarcinoma is rarely resected with a preoperative definitive diagnosis, especially nonpapillary flat type in situ carcinoma, which is extremely rare. Case presentation A 70-year old man was diagnosed with gallbladder cancer and received open cholecystectomy with lymphadenectomy at a local hospital. Histologically, the tumor was localized in the mucosal layer, and no lymph node metastases were found. Three months later, hilar bile duct stricture due to delayed bile duct ischemia was found. Then, biliary drainage was performed with endoscopic biliary stenting. Three months later, the patient experienced cholangitis with septic shock, and percutaneous transhepatic biliary drainage (PTBD) into the left intrahepatic bile duct was performed. Unexpectedly, the aspiration bile cytology of the PTBD catheter showed malignant cells, and the patient was referred to our clinic for possible surgical treatment. According to additional studies, the hilar bile duct stricture was 3 cm in length. None of the imaging studies detected malignant cells in the bile duct around the hilar stricture. The left portal vein was obstructed due to inadvertent puncture of the PTBD. No findings indicated cholangiocarcinoma. We performed left hepatectomy with caudate lobectomy and extrahepatic bile duct resection. The postoperative course was uneventful. In the final pathology, flat type in situ carcinoma was found at the confluence of the right and left hepatic ducts, which was distant from the biliary stricture. Conclusions When a tumor is undetectable but cytology is positive, in situ cholangiocarcinoma may exist; thus, surgery should be carefully considered.
Collapse
Affiliation(s)
- Takashi Maeda
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Nobuyuki Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| |
Collapse
|
|
29
|
Siripongsakun S, Sapthanakorn W, Mekraksakit P, Vichitpunt S, Chonyuen S, Seetasarn J, Bhumiwat S, Sricharunrat T, Srittanapong S. Premalignant lesions of cholangiocarcinoma: characteristics on ultrasonography and MRI. Abdom Radiol (NY) 2019; 44:2133-2146. [PMID: 30820627 DOI: 10.1007/s00261-019-01951-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Cholangiocarcinoma (CCA) is an aggressive malignancy with high prevalence rate in Asia. The CCA premalignant lesions, including Biliary intraepithelial neoplasia (Bil-IN) and Intraductal papillary neoplasm of biliary tract (IPNB), share a common carcinogenesis; however, on imaging, patterns of presentation are different. Patterns and imaging characteristics on ultrasonography (US) and Magnetic resonance imaging (MRI) of both Bil-IN and IPNB are reported herein. METHODS In this retrospective study of imaging findings in premalignant CCA, pathology-proven cases of Bil-IN and IPNB at Chulabhorn Hospital were analyzed. Demographics, locations of lesions, imaging characteristics of both Bil-IN and IPNB were assessed, compared, and described. RESULTS Twenty-one premalignant lesions, 13 Bil-INs and 8 IPNBs, from 18 patients were included. Both Bil-IN and IPNB lesions were found more commonly at the right than left intrahepatic ducts (66.7% vs. 33.3%), and had more peripheral than central locations (85.7% vs. 14.3%). On US, Bil-IN commonly presented as focal bile duct dilatation (76.9%), whereas IPNB was more variable with hyperechoic nodules (37.5%), focal bile duct dilatation (37.5%), and diffuse bile duct dilatation with intraductal nodules (25%). On MRI, focal bile duct dilatation and nonfunctioning bile excretion are the most sensitive findings with sensitivities in the range of 84.6% to 100%. The presence of intraductal nodules and connection to the biliary system are findings that were significantly different between IPNB and Bil-IN, 62.5% versus 7.7% (p = 0.014) and 75% versus 15.4% (p = 0.018), respectively. CONCLUSIONS Premalignant lesions of CCA, including Bil-IN and IPNB, have different imaging presentations. Knowledge of imaging presentations may improve early detection and increase confidence in diagnosis.
Collapse
|
|
30
|
Lee S, Kim MJ, Kim S, Choi D, Jang KT, Park YN. Intraductal papillary neoplasm of the bile duct: Assessment of invasive carcinoma and long-term outcomes using MRI. J Hepatol 2019; 70:692-699. [PMID: 30553839 DOI: 10.1016/j.jhep.2018.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/27/2018] [Accepted: 12/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Imaging characteristics for discriminating the malignant potential of intraductal papillary neoplasm of the bile duct (IPNB) still remain unclear. This study aimed to define the magnetic resonance (MR) imaging findings that help to differentiate IPNB with an associated invasive carcinoma from IPNB with intraepithelial neoplasia and to investigate their significance with respect to long-term outcomes in patients with surgically resected IPNB. METHODS This retrospective study included 120 patients with surgically resected IPNB who underwent preoperative MR imaging with MR cholangiography before surgery from January 2008 and December 2017 in two tertiary referral centers. Clinical and MR imaging features of IPNB with intraepithelial neoplasia (n = 34) and IPNB with an associated invasive carcinoma (n = 86) were compared. Regarding significant features for discriminating IPNB with or without an associated invasive carcinoma, recurrence-free survival (RFS) rates were evaluated. RESULTS Significant MR imaging findings for differentiating IPNB with an associated invasive carcinoma from IPNB with intraepithelial neoplasia were intraductal visible mass, tumor size ≥2.5 cm, multiplicity of the tumor, bile duct wall thickening, and adjacent organ invasion (all p ≤0.002). The 1-, 3-, and 5-year RFS rates for surgically resected IPNB were 93.8%, 79.1%, and 70.0%, respectively. RFS rates were significantly lower in patients with each significant MR imaging finding of IPNB with an associated invasive carcinoma than in those without significant MR imaging findings (all p ≤0.039). CONCLUSIONS MR imaging with MR cholangiography may be helpful in differentiating IPNB with an associated invasive carcinoma from IPNB with intraepithelial neoplasia. Significant MR imaging findings of IPNB with an associated invasive carcinoma have a negative impact on RFS. LAY SUMMARY Significant magnetic resonance imaging findings that differentiated between an intraductal papillary neoplasm of the bile duct (IPNB) with an associated invasive carcinoma and an IPNB with intraepithelial neoplasia were intraductal visible mass, tumor size ≥2.5 cm, multiplicity of the tumor, bile duct wall thickening, and adjacent organ invasion. Significant magnetic resonance imaging findings of invasive IPNB have a negative impact on recurrence-free survival.
Collapse
Affiliation(s)
- Sunyoung Lee
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Jin Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Sohee Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dongil Choi
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kee-Taek Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Nyun Park
- Department of Pathology, BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
|
31
|
Ritchie DJ, Okamoto K, White SL. Intraductal papillary mucinous neoplasm of the biliary tract: A precursor lesion to cholangiocarcinoma. Radiol Case Rep 2019; 14:495-500. [PMID: 30815047 PMCID: PMC6377392 DOI: 10.1016/j.radcr.2019.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 02/08/2023] Open
Abstract
Intraductal papillary mucinous neoplasm of the biliary tract (IPMN-B) is an increasingly recognized pathologic entity characterized by intraluminal papillary masses and increased mucin secretion, resulting in obstruction and dilation of the biliary tree. These lesions, rarely seen in clinical practice in the United States, are now considered to be important precursors for the development of cholangiocarcinoma. Therefore, it is critical that radiologists become familiar with the radiographic manifestations of IPMN-B in order to diagnosis these lesions at a time when surgical resection may be curative. Here we report a pathologically confirmed case of IPMN-B in a patient with chronic ulcerative colitis and subsequently discuss the main radiographic manifestations of this rare condition across multiple imaging modalities.
Collapse
Affiliation(s)
- David J Ritchie
- University of California, San Diego Health Systems, 200 W Arbor Dr, 8756, San Diego, CA 92103, USA
| | - Kanenori Okamoto
- University of California, San Diego Health Systems, 200 W Arbor Dr, 8756, San Diego, CA 92103, USA
| | - Stacey L White
- Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354, USA
| |
Collapse
|
|
32
|
Chatterjee A, Lopes Vendrami C, Nikolaidis P, Mittal PK, Bandy AJ, Menias CO, Hammond NA, Yaghmai V, Yang GY, Miller FH. Uncommon Intraluminal Tumors of the Gallbladder and Biliary Tract: Spectrum of Imaging Appearances. Radiographics 2019; 39:388-412. [PMID: 30707646 DOI: 10.1148/rg.2019180164] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Intraluminal pathologic conditions of the bile ducts and gallbladder are common, most frequently consisting of calculi and adenocarcinoma. In recent years, intraductal papillary neoplasm of the bile ducts (IPN-B), which is analogous to intraductal papillary mucinous neoplasm of the pancreas, has been recognized as a distinct pathologic entity and a precursor lesion to adenocarcinoma of the bile ducts. Intraductal tubulopapillary neoplasm (ITPN) of the bile duct was subsequently described as a distinct pathologic entity. With increased awareness and advances in imaging techniques, these lesions are diagnosed with increased frequency at preoperative imaging. A similar neoplasm in the gallbladder is referred to as intracholecystic papillary neoplasm. These lesions are often diagnosed at a preinvasive stage and have a better prognosis than invasive cholangiocarcinoma when treated with curative resection, underscoring the importance of an accurate imaging diagnosis. The most common causes of polypoid lesions of the gallbladder are cholesterol polyps and adenomyomatosis. These lesions need to be differentiated from the less common but clinically important adenocarcinoma of the gallbladder. Imaging is crucial to identify polyps that are at high risk for malignancy so that the appropriate management choice between imaging follow-up and cholecystectomy can be made by the treating physicians. Other less common gallbladder tumors, such as gallbladder adenomas, lymphoma, and metastases to the gallbladder, can manifest as intraluminal tumors; and awareness of these lesions is also important. In this article, the recent literature is reviewed; and the imaging appearances, histopathologic findings, and management of uncommon intraluminal tumors of the bile ducts and gallbladder and their mimics are discussed. ©RSNA, 2019.
Collapse
Affiliation(s)
- Argha Chatterjee
- From the Departments of Radiology (A.C., C.L.V., P.N., N.A.H., V.Y., F.H.M.) and Pathology (A.J.B., G.Y.Y.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Camila Lopes Vendrami
- From the Departments of Radiology (A.C., C.L.V., P.N., N.A.H., V.Y., F.H.M.) and Pathology (A.J.B., G.Y.Y.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Paul Nikolaidis
- From the Departments of Radiology (A.C., C.L.V., P.N., N.A.H., V.Y., F.H.M.) and Pathology (A.J.B., G.Y.Y.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Pardeep K Mittal
- From the Departments of Radiology (A.C., C.L.V., P.N., N.A.H., V.Y., F.H.M.) and Pathology (A.J.B., G.Y.Y.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Andrew J Bandy
- From the Departments of Radiology (A.C., C.L.V., P.N., N.A.H., V.Y., F.H.M.) and Pathology (A.J.B., G.Y.Y.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Departments of Radiology (A.C., C.L.V., P.N., N.A.H., V.Y., F.H.M.) and Pathology (A.J.B., G.Y.Y.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Nancy A Hammond
- From the Departments of Radiology (A.C., C.L.V., P.N., N.A.H., V.Y., F.H.M.) and Pathology (A.J.B., G.Y.Y.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Vahid Yaghmai
- From the Departments of Radiology (A.C., C.L.V., P.N., N.A.H., V.Y., F.H.M.) and Pathology (A.J.B., G.Y.Y.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Guang-Yu Yang
- From the Departments of Radiology (A.C., C.L.V., P.N., N.A.H., V.Y., F.H.M.) and Pathology (A.J.B., G.Y.Y.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Frank H Miller
- From the Departments of Radiology (A.C., C.L.V., P.N., N.A.H., V.Y., F.H.M.) and Pathology (A.J.B., G.Y.Y.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL 60611; Department of Radiology, Emory University School of Medicine, Atlanta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| |
Collapse
|
|
33
|
Kohli DR, Shah TU. Board Review Vignette: Intraductal Papillary Neoplasm of the Bile Duct. Am J Gastroenterol 2018; 113:639-641. [PMID: 29497137 DOI: 10.1038/s41395-018-0009-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/21/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA. Division of Gastroenterology and Hepatology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Tilak U Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA. Division of Gastroenterology and Hepatology, Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| |
Collapse
|
|
34
|
Intraductal Papillary Neoplasm of the Bile Duct: Clinical, Imaging, and Pathologic Features. AJR Am J Roentgenol 2018; 211:67-75. [PMID: 29629808 DOI: 10.2214/ajr.17.19261] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We outline the concept of intraductal papillary neoplasm of the bile duct (IPNB), discuss the morphologic features of IPNB and the differential diagnoses, and describe the radiologic approaches used in multidisciplinary management. CONCLUSION The concept of IPNB has been evolving. Because the imaging features of IPNB can be variable, different mimickers according to IPNB subtype can be considered. A multimodality approach is essential to obtain an optimal diagnosis and establish treatment plans.
Collapse
|
|
35
|
Tautenhahn HM, Brückner S, Rauchfuß F, Donndorf F, Ardelt M, Fahrner R, Tannapfel A, Settmacher U. [Precancerous and early stage cancer of the bile duct system]. Chirurg 2018; 89:274-280. [PMID: 29177915 DOI: 10.1007/s00104-017-0553-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Early stage cancer of the bile duct system is still difficult to diagnose. In cases of suspect lesions a stepwise diagnostic procedure consisting of computed tomography (CT), magnetic resonance imaging (MRI) with MR cholangiography (MRC) and possibly endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology should immediately be carried out. If there is a sufficient suspicion for premalignancy or early stage cancer the indications for surgical intervention should clearly be defined. Only resection can lead to a decrease in the recurrence rate and a better long-term outcome. If the patient is in a functionally nonresectable condition the possibility of liver transplantation should be considered.
Collapse
Affiliation(s)
- H-M Tautenhahn
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - S Brückner
- AG Zelltransplantation & Molekulare Hepatologie, Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - F Rauchfuß
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - F Donndorf
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - M Ardelt
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - R Fahrner
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - A Tannapfel
- Institut für Pathologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - U Settmacher
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| |
Collapse
|
|
36
|
Lai YS, Cheng CC, Lee MT, Chao WT, Lai YCC, Hsu YH, Liu YH. The Prognostic Value of Cytokeratin and Sal-Like Protein 4 Expression in Hepatocellular Carcinoma and Intra-Hepatic Cholangiocarcinoma in Taiwan. Int J Med Sci 2018; 15:1746-1756. [PMID: 30588199 PMCID: PMC6299409 DOI: 10.7150/ijms.28440] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023] Open
Abstract
Background: We previously reported that modulation of cytokeratin18 induces pleomorphism of liver cells, higher cell motility, and higher drug sensitivity to sorafenib treatment of hepatoma cells. These relationships were established by in vitro experiments. The aim of this study was to determine the in vivo association between cytokeratin expression and tumor behavior, as well as cancer stem cells of hepatocellular carcinoma and intra-hepatic cholangiocarcinoma in Taiwan. Methods: Cytokeratins and sal-like protein 4 expression was determined in 83 hepatocellular carcinoma and 30 intra-hepatic cholangiocarcinoma specimens by immunohistochemistry. The relationship between cytokeratins and sal-like protein 4 expression with hepatitis virus infection, clinicopathologic factors, and survival was analyzed. Further, the correlation among cytokeratins and sal-like protein 4 expression was studied. Results: In addition to cytokeratin8/18, the expression of cytokeratin7/19 and sal-like protein 4 was noted in hepatocellular carcinoma; however, only cytokeratin19 expression had a significant correlation with poor overall survival and poor disease-free survival. The expression of cytokeratins and sal-like protein 4 was not correlated with hepatitis virus infection. The expression of cytokeratin19, but not 7, 8, and 18, was correlated with sal-like protein 4 expression in hepatocellular carcinoma. Cytokeratin7 expression was decreased and the sal-like protein 4 expression was absent in all 30 intra-hepatic cholangiocarcinoma cases. The expression of cytokeratins had not statistically significant correlation with overall and disease-free survival in patients with intra-hepatic cholangiocarcinoma. Conclusions: The expression of cytokeratin19 was associated with sal-like protein 4 expression, as well as poor overall and disease-free survival in hepatocellular carcinoma patients in Taiwan.
Collapse
Affiliation(s)
- Yih-Shyong Lai
- Department of Pathology, Chang Bing Show Chwan Memorial Hospital, Changhua County 505, Taiwan
| | - Chiung-Chi Cheng
- Department of Pathology, Chang Bing Show Chwan Memorial Hospital, Changhua County 505, Taiwan.,Center for General Education, Providence University, Taichung City 433, Taiwan
| | - Ming-Tsung Lee
- Research Assistant Center, Show Chwan Memorial Hospital, Changhua City 500, Taiwan
| | - Wei-Ting Chao
- Department of Life Science, Tunghai University, Taichung City 407, Taiwan
| | - Yen-Chang Clark Lai
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung City 807, Taiwan
| | - Yung-Hsiang Hsu
- Department of Pathology, Tzu Chi University, Hualien County 970, Taiwan
| | - Yi-Hsiang Liu
- Department of Pathology, Chang Bing Show Chwan Memorial Hospital, Changhua County 505, Taiwan.,Department of Pathology, Tzu Chi University, Hualien County 970, Taiwan
| |
Collapse
|
|
37
|
Deimel A, Sturm J, Vielfort T, Zöpf T. [Upper abdominal pain and febrile episodes in a 44-year-old Filipino woman]. Internist (Berl) 2017; 59:276-281. [PMID: 28939930 DOI: 10.1007/s00108-017-0320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A 44-year-old Filipino woman presented with abdominal pain and fever. Clinical examination and blood tests revealed no pathological results; however, (cross-sectional) imaging showed saccular cystic bile duct dilatation in the right liver with solid intraductal masses. Due to the clinical presentation the patient was admitted for surgical intervention with the diagnosis of Caroli disease. During the surgical procedure histopathology showed an intraductal papillary neoplasm of the bile duct (IPNB). The planned segmentetomy was extended to hemihepatectomy. IPNB is a rare entity of premalignant lesions of the bile duct system first recognized by the World Health Organization in 2010.
Collapse
Affiliation(s)
- A Deimel
- ZEuS (Zentrum für Endoskopie und Ultraschall), Medizinische Klinik I, ViDiA Christliche Kliniken Karlsruhe, Diakonissenstr. 28, 76199, Karlsruhe, Deutschland.
| | - J Sturm
- Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, ViDiA Christliche Kliniken Karlsruhe, Diakonissenstraße 28, 79166 Karlsruhe, Deutschland
| | - T Vielfort
- Gemeinschaftspraxis für Pathologie an den ViDiA Christliche Kliniken Karlsruhe, Suedendstraße 37, 76137 Karlsruhe, Deutschland
| | - T Zöpf
- ZEuS (Zentrum für Endoskopie und Ultraschall), Medizinische Klinik I, ViDiA Christliche Kliniken Karlsruhe, Diakonissenstr. 28, 76199, Karlsruhe, Deutschland
| |
Collapse
|