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Journal of Hepato-Biliary-Pancreatic Sciences

Published in:

01-02-2013 | Original Article

Proposal for a morphological classification of intraductal papillary neoplasm of the bile duct (IPN-B)

Authors: Hiroyuki Kato, Masami Tabata, Yoshinori Azumi, Ichiro Osawa, Masashi Kishiwada, Takashi Hamada, Shugo Mizuno, Masanobu Usui, Hiroyuki Sakurai, Shuji Isaji

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 2/2013

Abstract

Purpose

We propose a morphological classification of intraductal papillary neoplasm of the bile duct (IPN-B).

Methods

A retrospective analysis of 16 patients with IPN-B who had undergone surgical resection was conducted. These 16 cases were classified into three types based on the primary lesion’s anatomical location: branch duct type (6 cases), main duct type (5 cases) and mixed type (5 cases). In this paper we have analyzed the characteristics of IPN-B according to our new classification.

Results

All branch duct type IPN-B was located in the left lobe and 5 of them were resected by left hepatectomy without extrahepatic bile duct resection (EBDR). On the other hand, all patients with main duct and mixed type IPN-B underwent EBDR in addition to hepatectomy or pancreatoduodenectomy. Microscopically, 2 of 6 patients with branch duct type IPN-B had no malignant component and, in the remaining 4 patients, cancer invasion was restricted to within the ductal wall. There were no cases of branch duct type IPN-B with lymph node metastasis and superficial intraductal tumor spread. In contrast, all patients with main duct and mixed duct type IPN-B had the malignant component. In all cases, lymph node metastasis was not observed, but superficial intraductal tumor spread was frequently found in extrahepatic bile duct lesions: 3 of main duct type and 3 of mixed type. Four patients with superficial intraductal spread had non-curative resection due to a cancer-positive ductal margin. Most patients with IPN-B obtained a good prognosis, but two patients with a cancer-positive ductal margin developed local recurrence.

Conclusions

Our classification vividly reflects clinical and pathological characteristics of IPN-B and is useful to determine appropriate surgical strategy.

Chen TC, Nakanuma Y, Zen Y, Chen MF, Jan YY, Yeh TS, et al. Intraductal papillary neoplasia of the liver associated with hepatolithiasis. Hepatology. 2001;34:651–8.PubMedCrossRef

Nakanuma Y, Sasaki M, Ishikawa A, Tsui W, Chen TC, Huang SF. Biliary papillary neoplasm of the liver. Histol Histopathol. 2002;17:851–61.PubMed

Lee SS, Kim MH, Lee SK, Jang SJ, Song MH, Kim KP. Clinicopathologic review of 58 patients with biliary papillomatosis. Cancer. 2004;100:783–93.PubMedCrossRef

Takayasu K, Muramatsu Y, Moriyama N, Yamada T, Hasegawa H, Hirohashi S, Ichikawa T, Ohno G. Imaging diagnosis of bile duct cystadenocarcinoma. Cancer. 1988;61:941–6.PubMedCrossRef

Yeh TS, Tseng JH, Chiu CT, Liu NJ, Chen TC, Jan YY, Chen MF. Cholangiographic spectrum of intraductal papillary mucinous neoplasm of the bile ducts. Ann Surg. 2006;244:248–53.PubMedCrossRef

Waters JA, Schmidt CM. Intraductal papillary mucinous neoplasm—when to resect? Adv Surg. 2008;42:87–108.PubMedCrossRef

Turrini O, Schmidt CM, Pitt HA, Guiramand J, Aguilar-Saavedra JR, Aboudi S, et al. Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: resection or enucleation? HPB (Oxford). 2011;13:126–31.CrossRef

Sauvanet A. Intraductal papillary mucinous neoplasms of the pancreas: indication, extent, and results of surgery. Surg Oncol Clin N Am. 2008;17:587–606.PubMedCrossRef

Nakanuma Y, Itatsu K, Zen Y. Intraductal Papillary Neoplasm of Bile Duct (IPN-B). Proposal and pathologic spectrum of a new disease entity. Jpn Biliary Assoc. 2007;21:45–54 (in Japanese).

10.

Zen Y, Sasaki M, Fujii T, Chen TC, Chen MF, Yeh TS, et al. Different expression patterns of mucin core proteins and cytokeratins during intrahepatic cholangiocarcinogenesis from biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile duct—an immunohistochemical study of 110 cases of hepatolithiasis. J Hepatol. 2006;44:350–8.PubMedCrossRef

11.

Nakanuma Y. A novel approach to biliary tract pathology based on similarities to pancreatic counterparts: is the biliary tract an incomplete pancreas? Pathol Int. 2010;60:419–29.PubMedCrossRef

12.

Sakamoto E, Nimura Y, Hayakawa N, Kamiya J, Kondo S, Kanai M, et al. The pattern of infiltration at the proximal order of hilar bile duct carcinoma: a histologic analysis of 62 resected cases. Ann Surg. 1998;227:405–11.PubMedCrossRef

13.

Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, Yamaguchi K, International Association of Pancreatology, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.PubMedCrossRef

14.

Nakanishi Y, Zen Y, Hirano S, Tanaka E, Takahashi O, Yonemori A, et al. Intraductal oncocytic papillary neoplasm of the bile duct: the first case of peribiliary gland origin. J Hepatobiliary Pancreat Surg. 2009;16:869–73.PubMedCrossRef

15.

Nakanishi Y, Nakanuma Y, Ohara M, Iwao T, Kimura N, Ishidate T, et al. Intraductal papillary neoplasm arising from peribiliary glands connecting with the inferior branch of the bile duct of the anterior segment of the liver. Pathol Int. 2011;61:773–7.PubMedCrossRef

16.

Sudo Y, Harada K, Tsuneyama K, Katayanagi K, Zen Y, Nakanuma Y. Oncocytic biliary cystadenocarcinoma is a form of intraductal oncocytic papillary neoplasm of the liver. Mod Pathol. 2001;14:1304–9.PubMedCrossRef

17.

Zen Y, Fujii T, Itatsu K, Nakamura K, Minato H, Kasashima S, et al. Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas. Hepatology. 2006;44:1333–43.PubMedCrossRef

18.

Shibahara H, Tamada S, Goto M, Oda K, Nagino M, Nagasaka T. Pathologic features of mucin-producing bile duct tumors: two histopathologic categories as counterparts of pancreatic intraductal papillary-mucinous neoplasms. Am J Surg Pathol. 2004;28:327–38.PubMedCrossRef

19.

Terada T, Nakanuma Y, Kakita A. Pathologic observations of intrahepatic peribiliary glands in 1000 consecutive autopsy livers. Heterotopic pancreas in the liver. Gastroenterology. 1990;98:1333–7.PubMed

20.

Bartman AE, Buisine MP, Aubert JP, et al. The MUC6 secretory mucin gene is expressed in a wide variety of epithelial tissues. J Pathol. 1998;186:398–405.PubMedCrossRef

21.

Choi SC, Lee JK, Jung JH, Lee JS, Lee KH, Lee KT, et al. The clinicopathological features of biliary intraductal papillary neoplasms according to the location of tumors. J Gastroenterol Hepatol. 2010;25:725–30.PubMedCrossRef

22.

Hruban RH, Takaori K, Klimstra DS, Adsay NV, Albores-Saavedra J, Biankin AV, et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2004;28:977–87.PubMedCrossRef

23.

Belyaev O, Seelig MH, Muller CA, Tannapfel A, Schmidt WE, Uhl W. Intraductal papillary mucinous neoplasms of the pancreas. J Clin Gastroenterol. 2008;42:284–94.PubMed

24.

Wakai T, Shirai Y, Moroda T, et al. Impact of ductal resection status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer. 2005;103:1210–6.PubMedCrossRef

25.

Nakanishi Y, Kondo S, Hirano S, Ambo Y, Tanaka E, Morikawa T, et al. Recurrence of mucosal carcinoma of the bile duct, with superficial flat spread, 12 years after operation. J Hepatobiliary Pancreat Surg. 2006;13:355–8.PubMedCrossRef

26.

Sasaki T, Kondo S, Ambo Y, Hirano S, Sichinohe T, Kaga K, et al. Local recurrence at hepaticojejunostomy 9 years after resection of bile duct cancer with superficial flat spread. J Hepatobiliary Pancreat Surg. 2006;13:458–62.PubMedCrossRef

Title: Proposal for a morphological classification of intraductal papillary neoplasm of the bile duct (IPN-B)
Authors: Hiroyuki Kato
Masami Tabata
Yoshinori Azumi
Ichiro Osawa
Masashi Kishiwada
Takashi Hamada
Shugo Mizuno
Masanobu Usui
Hiroyuki Sakurai
Shuji Isaji
Publication date: 01-02-2013
Publisher: Springer Japan
Published in: Journal of Hepato-Biliary-Pancreatic Sciences / Issue 2/2013
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI: https://doi.org/10.1007/s00534-012-0513-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Proposal for a morphological classification of intraductal papillary neoplasm of the bile duct (IPN-B)

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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