Precursor neoplastic lesions of the biliary tract

Abstract

Recently, the precursor neoplastic lesions of the bile duct tract have been classified using the same criteria used to classify the preinvasive lesions of the pancreas. Flat dysplasia and dysplastic mass-forming lesions of the bile duct system are considered precursor lesions of the adenocarcinomas and are frequently associated with invasive adenocarcinoma of the bile duct tract. The incidence and the histopathology of these dysplastic lesions are variable in different geographical areas. The prognosis of non-invasive dysplastic mass-forming lesions is very good if compared with lesions associated with adenocarcinoma and with conventional adenocarcinoma of the bile tract. Here, the main features of these lesions will be reviewed.

Updates on Precancerous Lesions of the Biliary Tract: Biliary Precancerous Lesion

“…5,6 Because of advances in radiographic imaging, massforming bile duct lesions, including IPN-B, are increasingly diagnosed. Also, an increase in elective cholecystectomies has raised the overall incidence of neoplastic lesions of the gallbladder.…”

“…9 Although IPN-B is common in the extrahepatic bile duct, hilum, and distal common bile duct according to Western literature, it is more frequently reported in the intrahepatic biliary tree in Southeast Asia, presumably reflecting the differences in predisposing factors and pathogenesis. 6,10 Abdominal pain and jaundice are the most common clinical symptoms of individuals with IPN-B. Mucin-producing variant of IPN-B presents with macroscopic mucin hypersecretion, impeding bile flow and resulting in obstructive jaundice and cholangitis.…”

“…Similar to its pancreatic counterpart, biliary mucinous cystic neoplasm is characterized by ovarian-like stroma of the cyst wall and columnar, mucin-containing biliary epithelium. 6 Mucinous cystic neoplasm is different from mucin-producing IPN-B. Unlike mucinous cystic neoplasm, IPN-B lacks ovarian-like stroma.…”

“…16 Biliary intraepithelial neoplasia is associated with conventional infiltrating tubular cholangiocarcinoma, which usually has a poorer prognosis compared with colloid (mucinous) adenocarcinoma. 6 Intraductal papillary neoplasm of the bile ducts is characterized by intraductal, predominantly papillary proliferation with a distinct fibrovascular stalk (Figure 3). The lining cells usually show intracellular mucin production.…”

“…Both MUC5AC and MUC6 are expressed in biliary epithelium in inflammatory conditions, such as primary sclerosing cholangitis. 6,15 The most common immunophenotype of BilIN is negativity for both MUC1 and MUC2, although an increased expression of MUC1 along with the progression of histologic grade of BilIN has been observed. 21 Likewise, tubular adenocarcinoma, which is commonly associated with BilIN, is characterized by the pancreatobiliary immunophenotype with positivity for CK7 and MUC1.…”