Intraductal Papillary Neoplasm of the Bile Duct
Intraductal papillary neoplasm of the bile duct (IPNB) is a grossly visible, preinvasive neoplasm of the bile duct that characteristically shows an intraductal predominant growth in dilated bile duct(s). IPNB is composed of a well-differentiated papillary
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Intraductal Papillary Neoplasm of the Bile Duct A Grossly Visible Preinvasive Neoplasm of the Bile Duct Yuki Fukumura, He Cong, Kieko Hara, Yuko Kakuda, and Yasuni Nakanuma
Abstract Intraductal papillary neoplasm of the bile duct (IPNB) is a grossly visible, preinvasive neoplasm of the bile duct that characteristically shows an intraductal predominant growth in dilated bile duct(s). IPNB is composed of a well-differentiated papillary or villous neoplasm covering delicate and ramifying fibrovascular stalks. Tubular components are usually admixed, although they usually constitute less than 50% of the neoplasm. IPNB is regarded as the counterpart of pancreatic intraductal papillary mucinous neoplasm (IPMN). As in IPMN, IPNB is divided into the intestinal, gastric, pancreatobiliary, and oncocytic subtypes and further classified into low-intermediate-grade and high-grade intraepithelial neoplasms. The cases of IPNB with invasion are called “IPNB with an associated invasive carcinoma.” IPNBs arising in the intrahepatic bile duct and right or left hepatic bile ducts are quite similar to IPMNs, whereas those arising in the extrahepatic bile duct, particularly in the distal bile ducts, show more aggressive features and more tubular components in comparison to IPMNs. Ordinary cholangiocarcinoma with an inconspicuous or low-height intraluminal papillary component, mucinous cystic neoplasms (MCNs), biliary intraepithelial neoplasia (BilIN), and intraductal tubulopapillary neoplasm should be distinguished from IPNB. Molecular and genetic analyses of more cases of IPNB with reference to IPMN are promising for the evaluation of pathologic and biologic heterogeneities associated with IPNB. Keywords Biliary tree • Intraductal papillary neoplasm • Preinvasive lesion Pancreatic counterpart • Cholangiocarcinoma
Y. Fukumura (*) • H. Cong • K. Hara Department of Human Pathology, Juntendo University, School of Medicine, Tokyo, Japan e-mail: [email protected] Y. Kakuda • Y. Nakanuma Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan © Springer Nature Singapore Pte Ltd. 2017 Y. Nakanuma (ed.), Pathology of the Bile Duct, DOI 10.1007/978-981-10-3500-5_13
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13.1 Introduction Biliary tract carcinomas are intractable malignant tumors that are diagnosed at advanced stages in most patients. Recently, biliary tumors showing grossly v isible and preinvasive intraductal papillary or polypoid lesions predominantly growing in the bile duct lumen have been the focus of interests for clinicians and researchers because they resemble pancreatic intraductal papillary mucinous neoplasms (IPMNs) and tubulopapillary neoplasms (ITPN). IPMN and ITPN are known as preinvasive neoplasms of the pancreas. Among these biliary neoplasms, the tumors predominantly growing intraductally showing well-differentiated papillary neoplasms covering delicate and ramifying fibrovascular stalks in dilated bile ducts were defined as “intraductal papillary neoplasms of the bile duct (IPNB)” by the World Health Organi
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