Published in:
01-03-2013 | Letter to the Editor
Non-invasive intraductal tubular adenoma, pyloric gland type, with malignant foci in the common bile duct
Published in: Medical Oncology | Issue 1/2013
Login to get accessExcerpt
Intraductal tubular neoplasm (ITN) of the pancreas is very rare; only several cases have been reported in the literature [1, 2]. However, ITN of the hepatobiliary system has not been reported. Herein reported is the first case of ITN, pyloric gland type, with malignant foci in the common bile duct (CBD). An 82-year-old man consulted our hospital because of obstructive jaundice. ERCP showed a mass in the lower CBD. A biopsy during ERCT revealed atypical tubules. Pancreaticoduodenectomy was performed. Grossly, a polypoid tumor (1 × 1 × 1 cm) was recognized in the lower CBD (Fig. 1a, b). Microscopically, the tumor consisted of tubular structures (adenoma of pyloric gland type) resembling pyloric glands (Figs. 1b, 2a). Foci of malignant transformation were seen in the periphery (Fig. 2b). The tumor was non-invasive. Histochemically, the tumor cells contained neutral and acidic mucins. Immunohistochemically, the tumor cells were positive for pancytokeratins (AE1/3 and CAM5.2), cytokeratin (CK) (34BE12, 5/6, 7, 8, 18, 19), CEA, CA19-9, CD56, HepPar1, MUC5AC and MUC6 (Fig. 3a). p53 was positive in carcinoma areas (Fig. 3b), but was negative in adenoma areas. Ki-67 labeling was 20 % in carcinoma areas, while it was 5 % in adenoma areas. The tumor was negative for CK 14, CK 20, NSE, EMA, HER2, vimentin, chromogranin, synaptophysin, CDX-2, MUC1 and MUC2. Non-invasive intraductal tubular adenoma (IPA), pyloric gland type, with malignant foci of the CMD was pathologically diagnosed. The patient is now free from tumor 5 months after the operation. Intraductal papillary, papillary mucinous, and oncocytic neoplasms occur both in pancreatic ducts and in bile duct [3, 4], reflecting similarity between both ducts. The present IPA expressed CK 34BE12 and CK5/6 in addition to pancreaticobiliary CKs (7, 8, 18, 19). The MUC-apomucin profile shows gastric type in the present case [5]. Expression of HepPar1 [3] and CD56 is strange. The expression of CEA, CA19-9, and p53 and high Ki-67 labeling in carcinoma areas indicates the malignant potential.
Fig. 1
Gross features (a) and very low microscopic features (b) of the tumor (arrows). The tumor is polypoid and is located in the lower common bile duct (a). The tumor is non-invasive and consisted of tubular structures (b). B: HE, ×10
Fig. 2
Microscopic features of the tumor. The tumor is mostly composed of non-atypical tubules resembling pyloric glands (a). At the periphery, carcinomatous foci are seen (b). A, B: HE, ×200
Fig. 3
Immunohistochemical findings of the tumor. The tumor cells are positive for MUC6 apomucin (a). The carcinomatous areas are positive for p53 protein (b). A, B: immunostaining, ×200
× ![]()
× ![]()
× ![]()
…