Hepatic intraductal oncocytic papillary carcinoma

Abstract

BACKGROUND There has been an increasing incidence and mortality from peripheral cholangiocarcinoma (PC) in the United States over the past 24 years. PC has been classified into two principal types, a mass‐forming type and a periductal‐infiltrating type, with a significant difference in the clinical behavior between the two. A third type, demonstrating a noninvasive intraductal growth of PC, was described as papillary PC. Rarely, papillary hepatic tumors composed of oncocytic cells have been described. Intraductal oncocytic papillary carcinomas (IOPCs) of the liver present as large, mucin‐filled, cystic lesions lined by noninvasive or focally microinvasive oncocytic tumors. METHODS From June 1999 to August 2001, three patients with hepatic IOPCs were identified in the files of the Hepatobiliary Service, Department of Surgery, and the Department of Pathology at Memorial Sloan‐Kettering Cancer Center. They form the basis of this study. We report the clinicopathologic presentation, as well as the outcome, with a review of the literature. RESULTS All three cases presented with well defined intrahepatic cystic masses ranging in size from 7.2 to 21.1 cm. The most prominent cells of the lining epithelium were columnar with oncocytic features showing abundant eosinophilic granular cytoplasm and centrally located nucleoli. All three patients underwent resection with one demonstrating local bile duct recurrence that was managed with stenting. Review of the literature has identified 39 patients with papillary PC and 2 patients with IOPC. The biology of these reported cases has been variable with overall survival better than that of nonpapillary PC patients, with recurrence in 15% of the reported cases. CONCLUSION Papillary PC is a rare type of cholangiocarcinoma that includes an interesting variant: IOPC. These tumors are predominantly found in men, who present with large (> 5 cm) mucinous cystic lesions of the bile duct. A noninvasive histology is seen, and long‐term survival may be achieved with complete resection. Invasive variants of IOPC have been reported in the literature and have a worse overall prognosis. Cancer 2002;95:2180–7. © 2002 American Cancer Society. DOI 10.1002/cncr.10934

Biliary cystic tumors with bile duct communication: a cystic variant of intraductal papillary neoplasm of the bile duct

“…From the view point of papillary proliferation, discrimination between IPN-B and biliary papillomatosis or cholangiocarcinoma of intraductal growth-type might be a problem. [29][30][31][32][33] We now speculate that most of biliary papillomatosis and cholangiocarcinoma of intraductal growth-type can be regarded as IPN-B, although a detailed clinicopathological study using a large numbers of cases is mandatory to conclude this issue. Biliary tumors with abundant mucin production have been called mucin-hypersecreting bile duct tumors.…”

Intraductal papillary neoplasm of the bile duct extending superficially from the intrahepatic to extrahepatic bile duct

“…[21][22][23][24]35 It is important to choose major hepatic resection in such cases because of the presence of diffuse dilatation of the bile duct extending in a segment or lobe and multifocal carcinogenesis. 2,5,11,24 In addition, the carcinoma in our patient extended superficially to the extrahepatic bile duct, which was an unexpected finding during the operation given the normal gross appearance.…”

Intraductal Papillary Cholangiocarcinoma Associated With von Meyenberg Complexes: A Case Report

“…In addition, focally hyperplastic epithelium with papillary structures ( ⇒ ) and mucinous epithelium ( ⇒ ) similar to intraductal papillary carcinoma is noted and intraductal variant of peripheral cholangiocarcinoma [4,9]. These tumors tend to have a cystic appearance due to dilatation of involved bile ducts [6], and need to be differentiated from other cystic neoplasms of the hepatobiliary system, for example, cystic cholangiocarcinoma or hepatobiliary cystadenoma. Clinicopathologic characteristics of IPC have been recently reviewed by Martin et al [6].…”

“…They are more common in men and occur more frequently in the sixth decade of life [6]. The tumors show 3 gross patterns: (1) mass forming, (2) periductal infiltrating, and (3) intraductal growth [4,8].…”

“…Cholangiocarcinoma is a primary malignancy of the liver second in prevalence only to hepatocellular carcinoma [4][5][6][7]. They are more common in men and occur more frequently in the sixth decade of life [6].…”