Diagnosis and treatment strategies for intraductal papillary neoplasm of the bile duct

doi:10.3877/cma.j.issn.2095-3232.2024.02.004

Abstract

Abstract:

Intraductal papillary neoplasm of the bile duct (IPNB) is a rare biliary neoplasm, which is characterized by intraductal papillary hyperplasia, complicated with biliary ductal system dilatation and possible intraductal mucus secretion. Clinical manifestations of IPNB are non-specific. According to different growth sites and grades of the neoplasm, it can be manifested as abdominal pain and obstructive jaundice. Patients complicated with biliary tract infection develop symptoms of acute cholangitis, such as fever and chills, etc. Blood test may indicate abnormal liver function and elevated bilirubin levels. Imaging examinations consist of abdominal ultrasound, plain or enhanced CT, MRI and endoscopic ultrasound, etc. Current imaging tools fail to make a highly-specific and effective differential diagnosis of IPNB before operation. At present, surgical resection is recommended as the optimal treatment. Surgical approaches include pancreaticoduodenectomy, choledochotomy + cholangiojejunostomy, radical resection of hilar cholangiocarcinoma + partial hepatectomy, etc. There is no definite evidence to prove the necessity of adjuvant chemoradiotherapy after surgical resection.

Key words: Intraductal papillary neoplasm of bile duct, Precancerous lesions, Mucus secretion, Molecular mechanism

Haonian Wang, Bei Sun, Hua Chen. Diagnosis and treatment strategies for intraductal papillary neoplasm of the bile duct[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(02): 140-144.

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References 31

[1]	Sakamoto E, Nimura Y, Hayakawa N, et al. Clinicopathological studies of mucin-producing cholangiocarcinoma[J]. J Hepato Biliary Pancreat Surg, 1997, 4(2):157-162.
[2]	Ohtsuka M, Shimizu H, Kato A, et al. Intraductal papillary neoplasms of the bile duct[J]. Int J Hepatol, 2014:459091.
[3]	Gordon-Weeks AN, Jones K, Harriss E, et al. Systematic review and meta-analysis of current experience in treating IPNB: clinical and pathological correlates[J]. Ann Surg, 2016, 263(4):656-663.
[4]	Zen Y, Fujii T, Itatsu K, et al. Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas[J]. Hepatology, 2006, 44(5):1333-1343.
[5]	Zaccari P, Cardinale V, Severi C, et al. Common features between neoplastic and preneoplastic lesions of the biliary tract and the pancreas[J]. World J Gastroenterol, 2019, 25(31):4343-4359.
[6]	Luvira V, Pugkhem A, Bhudhisawasdi V, et al. Long-term outcome of surgical resection for intraductal papillary neoplasm of the bile duct[J]. J Gastroenterol Hepatol, 2017, 32(2):527-533.
[7]	Zen Y, Jang KT, Ahn S, et al. Intraductal papillary neoplasms and mucinous cystic neoplasms of the hepatobiliary system: demographic differences between Asian and Western populations, and comparison with pancreatic counterparts[J]. Histopathology, 2014, 65(2):164-173.
[8]	Wan XS, Xu YY, Qian JY, et al. Intraductal papillary neoplasm of the bile duct[J]. World J Gastroenterol, 2013, 19(46):8595-8604.
[9]	Nakanuma Y, Uesaka K, Kakuda Y, et al. Intraductal papillary neoplasm of bile duct:updated clinicopathological characteristics and molecular and genetic alterations[J]. J Clin Med, 2020, 9(12):3991.
[10]	Jang KT, Hong SM, Lee KT, et al. Intraductal papillary neoplasm of the bile duct associated with Clonorchis sinensis infection[J]. Virchows Arch, 2008, 453(6):589-598.
[11]	Kubo S, Nakanuma Y, Takemura S, et al. Case series of 17 patients with cholangiocarcinoma among young adult workers of a printing company in Japan[J]. J Hepatobiliary Pancreat Sci, 2014, 21(7):479-488.
[12]	Rocha FG, Lee H, Katabi N, et al. Intraductal papillary neoplasm of the bile duct:a biliary equivalent to intraductal papillary mucinous neoplasm of the pancreas?[J]. Hepatology, 2012, 56(4):1352-1360.
[13]	Han SY, Kim DU, Nam HS, et al. Comparison of the malignant predictors in intrahepatic and extrahepatic intraductal papillary neoplasm of the bile duct[J]. J Clin Med, 2022, 11(7):1985.
[14]	Yoon HJ, Kim YK, Jang KT, et al. Intraductal papillary neoplasm of the bile ducts:description of MRI and added value of diffusion-weighted MRI[J]. Abdom Imaging, 2013, 38(5):1082-1090.
[15]	Sakai, Ohtsuka M, Sugiyama H, et al. Current status of diagnosis and therapy for intraductal papillary neoplasm of the bile duct[J]. World J Gastroenterol, 2021, 27(15):1569-1577.
[16]	Miyata T, Uesaka K, Nakanuma Y. Cystic and papillary neoplasm at the hepatic hilum possibly originating in the peribiliary glands[J]. Case Rep Pathol, 2016, 2016:9130754.
[17]	Pehlivanoglu B, Adsay V. Intraductal tubulopapillary neoplasmsof the bile ducts:identity, clinicopathologic characteristics, and differential diagnosis of a distinct entity among intraductal tumors[J]. Hum Pathol, 2023(132):12-19.
[18]	Adsay V, Jang KT, Roa JC, et al. Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder (neoplastic polyps, adenomas, and papillary neoplasms that are≥1.0 cm): clinicopathologic and immunohistochemical analysis of 123 cases[J]. Am J Surg Pathol, 2012, 36(9):1279-1301.
[19]	吴昕, 李秉璐, 郑朝纪, 等. 胆管导管内乳头状肿瘤的临床病理特征与治疗策略[J]. 中华消化外科杂志, 2021, 20(8):876-882.
[20]	Nakanuma Y, Uesaka K, Miyayama S, et al. Intraductal neoplasms of the bile duct. a new challenge to biliary tract tumor pathology[J]. Histol Histopathol, 2017, 32(10):1001-1015.
[21]	Onoe S, Ebata T, Yokoyama Y, et al. A clinicopathological reappraisal of intraductal papillary neoplasm of the bile duct (IPNB):a continuous spectrum with papillary cholangiocarcinoma in181 curatively resected cases[J]. HPB, 2021, 23(10):1525-1532.
[22]	Ohtsuka M, Kimura F, Shimizu H, et al. Similarities and differences between intraductal papillary tumors of the bile duct with and without macroscopically visible mucin secretion[J]. Am J Surg Pathol, 2011, 35(4):512-521.
[23]	Tomita H, Tanaka K, Hirata A, et al. Inhibition of FGF10-ERK signal activation suppresses intraductal papillary neoplasm of the bile duct and its associated carcinomas[J]. Cell Rep, 2021, 34(8):108772.
[24]	Goeppert B, Stichel D, Toth R, et al. Integrative analysis reveals early and distinct genetic and epigenetic changes in intraductal papillary and tubulopapillary cholangiocarcinogenesis[J]. Gut, 2022, 71(2):391-401.
[25]	Sasaki M, Matsubara T, Nitta T, et al. GNAS and KRAS mutations are common in intraductal papillary neoplasms of the bile duct[J]. PLoS One, 2013, 8(12):e81706.
[26]	Date K, Ohtsuka T, Fujimoto T, et al. GNAS and KRAS mutational analyses of intraductal papillary neoplasms of the pancreas and bile duct developing in the same individual:a case report[J]. Pancreatology, 2015, 15(6):713-716.
[27]	Tsai JH, Liau JY, Yuan CT, et al. RNF43 mutation frequently occurs with GNAS mutation and mucin hypersecretion in intraductal papillary neoplasms of the bile duct[J]. Histopathology, 2017, 70(5):756-765.
[28]	郭伟, 张忠涛. 胆管内乳头状肿瘤的诊断与治疗[J]. 中华消化外科杂志, 2018, 17(3):233-236.
[29]	Krawczyk M, Ziarkiewicz-Wróblewska B, Podgórska J, et al. Intraductal papillary neoplasm of the bile duct-a comprehensive review[J]. Adv Med Sci, 2021, 66(1):138-147.
[30]	蔡慧强, 耿智敏. 胆管内乳头状肿瘤的研究进展[J]. 中华消化外科杂志, 2017, 16(8):879-882.
[31]	Hu LH, Liu MH, Liao Z, et al. Continuous infusion of N-acetylcysteine by nasobiliary for advanced intraductal papillary mucinous neoplasm of bile ducts (with video)[J]. Am J Gastroenterol, 2012, 107(12):1929-1930.

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