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Intraductal papillary neoplasm of the bile duct:The new frontier of biliary pathology

World Journal of Gastroenterology 2023年第38期29卷 5361-5373页

作者： Federico Mocchegiani Paolo Vincenzi Grazia Conte Daniele Nicolini Roberta Rossi Andrea Benedetti Cacciaguerra Marco Vivarelli Department of Experimental and Clinical Medicine Polytechnic University of MarcheAncona 60126Italy Department of Gastroenterology and Transplant United Hospital of MarcheAncona 60126Italy

Intraductal papillary neoplasms of the bile duct(IPNBs)represent a rare variant of biliary tumors characterized by a papillary growth within the bile duct *** their first description in 2001,several classifications have been proposed,mainly based on histopathological,radiological and clinical features,although no specific guidelines addressing their management have been *** duct neoplasms generally develop through a multistep process,involving different precursor pathways,ranging from the initial lesion,detectable only microscopically,*** intraepithelial neoplasia,to the distinctive grades of IPNB until the final stage represented by invasive *** and advanced investigations,mainly relying on magnetic resonance imaging(MRI)and cholangioscopy,are required to reach a correct diagnosis and to define an adequate bile duct mapping,which supports proper *** recently introduced subclassifications of types 1 and 2 highlight the histopathological and clinical aspects of IPNB,as well as their natural evolution with a particular focus on prognosis and *** surgical resection,including hepatectomy,pancreaticoduodenectomy or both,represents the treatment of choice,yielding optimal results in terms of survival,although several endoscopic approaches have been *** are newly recognized preinvasive neoplasms of the bile duct with high malignant *** novel subclassification of types 1 and 2 defines the histological and clinical aspects,prognosis and *** is mainly based on MRI and *** resection represents the mainstay of treatment,although endoscopic resection is currently applied to nonsurgically fit *** frontiers in genetic research have identified the processes underlying the carcinogenesis of IPNB,to identify targeted therapies.

关键词： Intraductal neoplasm of the bile duct bile duct neoplasms Cholangiocarcinoma Intraductal papilloma Classification Treatment

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Intraductal papillary neoplasm of the bile duct in liver cirrhosis with hepatocellular carcinoma

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World Journal of Gastroenterology 2011年第14期17卷 1923-1926页

作者： Jing Xu Yasunori Sato Kenichi Harada Norihide Yoneda Yasuni Nakanuma Teruyuki Ueda Atsushi Kawashima Akishi Ooi Department of Human Pathology Kanazawa University Graduate School of Medicine Kanazawa 920-8640 Japan Department of Pathology Shanxi Medical University Taiyuan 030001 Shanxi Province China Internal Medicine for Digestive Organs Kanazawa University Graduate School of Medicine Kanazawa 920-8640 Japan Department of Molecular Pathology Kanazawa University Graduate School of Medicine Kanazawa 920-8640 Japan

A case of intraductal papillary neoplasm of the bile duct (IPNB) arising in a patient with hepatitis B-related liver cirrhosis with hepatocellular carcinoma (HCC) is reported. A 76-year-old man was admitted to our hospital with recurrent HCC. Laboratory data showed that levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated. He died of progressive hepatic failure. At autopsy,in addition to HCCs,an intraductal papillary proliferation of malignant cholangiocytes with fibrovascular cores was found in the dilated large bile ducts in the left lobe,and this papillary carcinoma was associated with an invasive mucinous carcinoma (invasive IPNB). Interestingly,extensive intraductal spread of the cholangiocarcinoma was found from the reactive bile ductular level to the interlobular bile ducts and septal bile ducts and to the large bile ducts in the left lobe. Neural cell adhesion molecule,a hepatic progenitor cell marker,was detected in IPNB cells. It seems possible in this case that hepatic progenitor cells located in reactive bile ductules in liver cirrhosis may have been responsible for the development of the cholangiocarcinoma and HCC,and that the former could have spread in the intrahepatic bile ducts and eventually formed grossly visible IPNB.

关键词： Papillary carcinoma bile duct neoplasms Liver cirrhosis Progenitor cells Hepatocellular carcinoma Neural cell adhesion molecules

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Portal venous arterialization resulting in increased portal inflow and portal vein wall thickness in rats

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World Journal of Gastroenterology 2008年第43期14卷 6681-6688页

作者： Wen-Gang Li Yong-Liang Chen Jing-Xi Chen Lei Qu Bin-Dang Xue Zhi-Hai Peng Zhi-Qiang Huang Department of Hepatobiliary Pancreas and Vessel Surgery Xiamen First Hospital Attached Fujian Medical University Xiamen 361003 Fujian Province China Institute of Hepatobiliary Surgery General Hospital ofPLA Beijing 100853 China Image Processing Centre Beijing University of Aeronautics and Astronautics Beijing 100083 China

AIM： To explore the influence of portal vein hemodynamic changes after portal venous arterialization （PVA） on peribiliary vascular plexus （PVP） morphological structure and hepatic pathology, and to establish a theoretical basis for the clinical application of PVA. METHODS： Sprague-Dawley rats were randomly divided into control and PVA groups. After PVA, hemodynamic changes of the portal vein and morphological structure of hepatohilar PVP were observed using Doppler ultrasound, liver function tests, ink perfusion transparency management and three-dimensional reconstruction of computer microvisualization, and pathological examination was performed on tissue from the bile duct wall and the liver. RESULTS： After PVA, the cross-sectional area and blood flow of the portal vein were increased, and the increase became more significant over time, in a certain range. If the measure to limit the flow in PVA was not adopted, the high blood flow would lead to dilatation of intrahepatic portal vein and its branches, increase in collagen and fiber degeneration in tunica intima. Except glutamic pyruvic transaminase （GPT）, other liver function tests were normal. CONCLUSION： Blood with a certain flow and oxygen content is important for filling the PVP and meeting the oxygen requirement of the bile duct wall. After PVA, It is the anatomic basis to maintain normal morphology of hepatohilar bile duct wall that the blood with high oxygen content and high flow in arterialized portal vein may fill PVP by collateral vessel reflux. A adequate measure to limit blood flow is necessary in PVA.

关键词： Peribiliary vascular plexus Portal venous arterialization Liver transplantation bile duct neoplasms Three-dimensional reconstruction Hemodynamics

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Multivariate analysis by Cox Proportional Hazards Model on pro gnoses of patients with bile duct carcinoma after resection

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Chinese Medical Journal 2002年第10期115卷 1538-1541页

作者：何平石景森陈武科王作仁西安交通大学第一医院肝胆外科研究室西安710061

OBJECTIVE: To evaluate the influence of various clinicopathologic factors on the survival of patients with bile duct carcinoma after curative resection. METHODS: A retrospective analysis was performed on 86 cases of bile duct carcinoma treated from January 1981 to September 1995. Fifteen clinicopathologic factors that could possibly influence survival were selected. A multivariate analysis of these individuals was performed using the Cox Proportional Hazards Model. RESULTS: The overall cumulative survival rate was 73% for 1 year, 32% for 3 years and 19% for 5 years. The results of univariate analysis showed that the major significant prognostic factors for influencing survival of these patients were type of histological lesion, lymph node metastasis, pancreatic invasion, duodenal invasion, perineural invasion, macroscopic vessel involvement, resected surgical margin and depth of cancer invasion (P

关键词： Proportional Hazards Models Adult Aged bile duct neoplasms Female Humans Lymphatic Metastasis Male Middle Aged Multivariate Analysis Neoplasm Invasiveness Prognosis Survival Rate

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Peroral cholangioscopy for non-invasive papillary cholangio-carcinoma with extensive superficial ductal spread

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World Journal of Gastroenterology 2005年第41期11卷 6554-6556页

作者： Toshifumi Wakai Yoshio Shirai Katsuyoshi Hatakeyama Division of Digestive and General Surgery Niigata University Graduate School of Medical and Dental Sciences NiigataJapan

Papillary carcinoma arising from the extrahepatic bile duct often shows superficial ductal spread. We report herein the case of a patient with extensive superficial spread of non-invasive papillary cholangiocarcinoma,which was depicted with peroral cholangioscopy. A 65-year-old woman presented with the sudden-onset of severe epigastric pain. Ultrasonography revealed acute acalculous cholecystitis. Endoscopic retrograde cholangiography found small protruding lesions around the confluence of the cystic duct, suggestive of a cholangiocarcinoma. As the contour of the middle and upper bile ducts it was slightly irregular on the cholangiogram, the presence of superficial ductal spread was suspected. Peroral cholangioscopy revealed small papillary lesions around the confluence of the cystic duct and fine granular mucosal lesions in the middle and upper bile ducts and the right hepatic duct, suggesting a superficially spreading tumor. A right hepatectomy with bile duct resection was performed and no residual tumor was found. Histological examination revealed a non-invasive papillary carcinoma arising from the cystic duct with extensive superficial spread. Our experience of this case and a review of the literature suggest that a fine granular or fine papillary appearance of the ductal mucosae on cholangioscopy indicates superficial spread of papillary cholangiocarcinoma, for which peroral cholangioscopy is an efficient diagnostic option.

关键词： Cholangiocarcinoma bile duct neoplasms Peroral cholangioscopy Papillary carcinoma Superficial ductal spread Surgery

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Role of serum total sialic acid in differentiating cholangiocarcinoma from hepatocellular carcinoma

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World Journal of Gastroenterology 2003年第10期9卷 2178-2181页

作者： Prachya Kongtawelert Pisit Tangkijvanich Siriwan Ong-Chai Yong Poovorawan Department of Biochemistry Faculty of Medicine Chiang Mai University Chiang Mai 50200 Thailand Department of Biochemistry Faculty of Medicine Chulalongkorn University Bangkok 10330 Thailand Viral Hepatitis Research Unit Department of Pediatrics Faculty of Medicine Chulalongkorn University Bangkok 10330 Thailand

AIM:This study was designed to evaluate the clinical application of serum total sialic acid (TSA) in the diagnosis of cholangiocarcinoma (CCA).METHODS: Serum TSA was determined by periodateresorcinol microassay in 69 patients with CCA, 59 patients with hepatocellular carcinoma (HCC), 37 patients with cirrhosis, 61 patients with chronic hepatitis and 50 healthy blood ***: The mean serum TSA concentration in CCA (2.41±0.70 mmol/L) was significantly higher than those of HCC, cirrhosis, chronic hepatitis and healthy blood donors (1.41±0.37 mmol/L, 1.13±0.31 mmol/L, 1.16±0.26 mmol/L, and 1.10±0.14 mmol/L, respectively; P＜0.001). Based on ROC curve analysis, a cut-off point of 1.75 mmol/L discriminated between CCA and HCC with a sensitivity,specificity and accuracy of 82.6%, 83.1%, and 82.8%,***: Based on our results, serum TSA would be a useful marker for the differential diagnosis of CCA from HCC.

关键词： Adult Aged bile duct neoplasms Carcinoma, Hepatocellular Cholangiocarcinoma Diagnosis, Differential Female Hepatitis, Chronic Humans Liver Cirrhosis Liver neoplasms Male Middle Aged N-Acetylneuraminic Acid Research Support, Non-U.S. Gov't Tumor Markers, Biological

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Synchronous Double Primary Combined Hepatocellularcholangiocarcinoma and Cholangiolocarcinoma in a Cirrhotic Liver

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Journal of Clinical and Translational Hepatology 2023年第4期11卷 991-997页

作者： Masahiro Sakata Koji Kitada Rika Omote Hiroshi Sonobe Masashi Utsumi Naoyuki Tokunaga Takashi Fushimi Ryota Nagao Tatsuro Sakata Toshihiko Kaneyoshi Tatsuya Toyokawa Masaru Inagaki Department of Gastroenterology and Hepatology National Hospital OrganizationFukuyama Medical CenterFukuyamaHiroshimaJapan Department of Surgery National Hospital OrganizationFukuyama Medical CenterFukuyamaHiroshimaJapan Department of Laboratory and Pathology National Hospital OrganizationFukuyama Medical CenterFukuyamaHiroshimaJapan Department of Radiology National Hospital OrganizationFukuyama Medical CenterFukuyamaHiroshimaJapan

Both combined hepatocellular-cholangiocarcinoma(cHCCCCA)and cholangiolocarcinoma are rare primary liver ***-CCA is believed to originate from transformed hepatocellular carcinoma or liver stem/progenitor *** is characterized by ductular reaction-like anastomosing cords and glands resembling cholangioles or canals containing hepatocellular carcinoma components and adenocarcinoma *** to the 2019 revision of the World Health Organization criteria,a subtype with stem cell features as a subclassification of cHCC-CCA was abolished for lack of conclusive evidence of the stem cell origin *** led to the classification of cholangiolocarcinoma with hepatocytic differentiation as ***,cholangiolocarcinoma without hepatocytic differentiation is classified as a subtype of small-duct cholangiocarcinoma and is assumed to originate from the bile ***,we report the first case of double primary cHCC-CCA and cholangiolocarcinoma without hepatocytic differentiation in different hepatic segments of a cirrhotic *** believe this case supports the validity of the new World Health Organization criteria because the pathological finding of cHCC-CCA in this case shows the transformation of hepatocellular carcinoma to ***,this case may demonstrate that immature ductular cell stemness and mature hepatocyte cell stemness in hepatocarcinogenesis can coexist in the same *** results provide valuable insights into the mechanisms of growth,differentiation,and regulation of liver cancers.

关键词： bile duct neoplasms Combined hepatocellular-cholangiocarcinoma Cholangiolocarcinoma Cirrhosis Liver neoplasms

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Diagnosis and surgical treatment of hepatic hilar cholangiocarcinoma

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Hepatobiliary & Pancreatic Diseases International 2007年第6期6卷 631-635页

作者： Yang, Wei-Liang Zhang, Xin-Chen Zhang, Dong-Wei Tong, Bai-Feng Harbin Med Coll Affiliated Hosp 2 Dept Gen Surg Harbin 150086 Peoples R China

BACKGROUND: Hepatic hilar cholangiocarcinoma can be diagnosed early with the progress in diagnostic imaging, and thus the rate of resection of the tumor has increased markedly. To assess the effectiveness of resection, we reviewed 185 cases of hepatic hilar cholangiocarcinoma diagnosed and treated at our hospital. METHODS: The clinical data of 185 patients with hepatic hilar cholangiocarcinoma who had been treated surgically from 1972 to 2006 were retrospectively analyzed. RESULTS: The records of the 185 patients were divided into first stage (1972-1986) or second stage (1987-2006) according to the incidence of the tumor and its resection rate. Primary symptoms included upper abdominal discomfort or pain, anorexia, tiredness, weight loss and progressive jaundice. Ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) were first line methods for atraumatic diagnosis. If the patients displayed intrahepatic bile duct dilatation or were diagnosed as suffering from extrahepatic obstructive jaundice, percutaneous transhepatic cholangiography (PTC), MRCP or endoscopic retrograde cholangiopancreatography (ERCP) should be used. In this series, 87 patients underwent resection of the tumor (47.0%). Of the 87 patients, 43 received radical resection and 44 palliative resection. Fifteen patients underwent resection in the first stage and 72 in the second stage. A total of 74 patients were followed up after the resection. The median survival time of the radical resection group was 37 months and that of the palliative resection group was 17 months (P<0.001). The other 62 patients receiving no resection died within 1.5 years. CONCLUSIONS: Once patients are diagnosed with hepatic hilar cholangiocarcinoma, they should undergo exploratory laparotomy. Resection is the most effective method for the treatment of hepatic hilar cholangiocarcinoma.

关键词： bile duct neoplasms hepatic hilar cholangiocarcinoma diagnosis surgical treatment

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Successful endoscopic treatment of an intraductal papillary neoplasm of the bile duct

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World Journal of Gastrointestinal Endoscopy 2017年第5期9卷 238-242页

作者： Nikola S Natov Laura C Horton Sanjay R Hegde the Gastroenterology/Hepatology Division Tufts Medical Center Department of Medicine Brigham and Women’s Hospital

We present a case of a 76-year-old man with right upper quadrant abdominal pain and weight loss,who was found to have an intraductal papillary neoplasm of the bile duct(IPNB)of the pancreaticobiliary subtype,deemed curatively *** patient declined surgery and opted for endoscopic *** underwent two sessions of endoscopic retrograde cholangiopancreatography(ERCP)-guided radiofrequency ablation(RFA).Ten months later,no evidence of recurrence was identified on repeat *** our knowledge,this is the first reported case of successful use of RFA as a primary treatment modality for resectable IPNB.

关键词： bile duct neoplasms Ablation technique Common bile duct diseases Extrahepatic bile duct Advanced endoscopy

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EXPRESSION OF X-GENE TRANSLATION PROduct IN HUMAN PRIMARY CHOLANGIOCARCINOMA AND ITS SURROUNDING NONTUMOROUS TISSUES

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Chinese Journal of Cancer Research 1993年第2期5卷 4-7页

作者：胡敏王文亮朱新生 Department of Pathology Fourth Military Medical University Xi' an 710032 Department of Pathology Fourth Military Medical University Xi' an 710032ntrahepatic cholangiocarcinoma is an uncommon type of primary hepatoma and its mechanism is still unknown. Twenty samples of the cancer and the tissues surrounding it were all taken from the Xi' an area and examined for the presence of X-gene product (HBxAg) by the avldin-biotin-peroxidase complex method. It was found that 17 cases (85%) showed positive reaction HBxAg was present in 15 cancer samples and 16 non-tumor tissue samples. This result suggests that there is a close relationship between human choiangiocarcinoma and HBV and the HBxAg might play an important role in the pathogenesis of cholanglocarcinoma.

Intrahepatic cholangiocarcinoma is an uncommon type of primary hepatoma and its mechanism is still unknown. Twenty samples of the cancer and the tissues surrounding it were all taken from the Xi' an area and examined for the presence of X-gene product (HBxAg) by the avldin-biotin-peroxidase complex method. It was found that 17 cases (85%) showed positive reaction, HBxAg was present in 15 cancer samples and 16 non-tumor tissue samples. This result suggests that there is a close relationship between human choiangiocarcinoma and HBV, and the HBxAg might play an important role in the pathogenesis of cholanglocarcinoma.

关键词： bile duct neoplasms Hepatitis B virus X-gene Enzyme immunoassay

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