Intraductal papillary mucinous neoplasm of the biliary tract: A precursor lesion to cholangiocarcinoma

Abstract

Intraductal papillary mucinous neoplasm of the biliary tract (IPMN-B) is an increasingly recognized pathologic entity characterized by intraluminal papillary masses and increased mucin secretion, resulting in obstruction and dilation of the biliary tree. These lesions, rarely seen in clinical practice in the United States, are now considered to be important precursors for the development of cholangiocarcinoma. Therefore, it is critical that radiologists become familiar with the radiographic manifestations of IPMN-B in order to diagnosis these lesions at a time when surgical resection may be curative. Here we report a pathologically confirmed case of IPMN-B in a patient with chronic ulcerative colitis and subsequently discuss the main radiographic manifestations of this rare condition across multiple imaging modalities.

Intraductal papillary mucinous neoplasm of the biliary tract with cardiac metastasis

“…Furthermore, the rate of metastasis from an IPNB to organs other than the heart has been reported to be low. [ 22 ] In our case, the identified periampullary lesion was accompanied by invasive adenocarcinoma.…”

Intraductal papillary mucinous neoplasm of biliary ducts: Literature review and a case report with emphasis on radiological manifestation

“…Different subtypes are described for B-IPMN with different imaging features based on CT scan and magnetic resonance imaging (MRI) as follow: [ 14 ]…”

“…[ 10 ] To differentiate from cholangiocarcinoma, it should be considered that in contrast to cholangiocarcinoma, B-IPMN tumors do not show enhancement on delayed imaging, because B-IPMN typically does not have fibrous tissue. Although for this subtype of B-IPMN, cholangiocarcinoma, hepatocellular carcinoma with bile duct invasion, intraductal metastasis, and hepatolithiasis (lack of enhancement on contrast-enhanced study) should be kept in mind in differential diagnosis[ 14 ] Cystic mass-like appearance because of focal aneurysmal dilation of biliary duct with variable downstream bile duct. Some authors emphasized that focal aneurysmal dilation of any branch of bile duct system can be a characteristic manifestation of IPMN-B.…”

“…Some authors emphasized that focal aneurysmal dilation of any branch of bile duct system can be a characteristic manifestation of IPMN-B. [ 8 ] For this subtype, localized Caroli disease, cystadenoma, and cystadenocarcinoma are in differential diagnosis[ 14 ] as may appear as a cystic mass. In differentiating of MCN versus IPMN (both with mucinous cells on pathology and cystic appearance on imaging), one should know that MCN is more frequently detected in women while B-IPMN does not have a sexual preference.…”

“…Some authors emphasized that focal aneurysmal dilation of any branch of bile duct system can be a characteristic manifestation of IPMN-B. [ 8 ] For this subtype, localized Caroli disease, cystadenoma, and cystadenocarcinoma are in differential diagnosis[ 14 ] as may appear as a cystic mass.…”