Non-invasive intraductal papillary neoplasms of the common bile duct: a clinicopathologic study of six cases

Abstract

Recently, several studies of intraductal papillary neoplasms (IPN) of the biliary tracts have been reported in the liver, but there have been only one study of them in the common bile duct (CBD). The author reviewed 34 archival pathologic materials of surgically resected specimens containing CBD tumors.

Results: Six cases (18%) of IPN of the CBD were found. All cases were non-invasive intraductal papillary carcinomas (IPC). The age of the patients with IPC ranged from 49 to 77 years with a mean of 67 years. The male to female ratio was 4:2. The initial symptoms were abdominal pain in 2 cases, abdominal discomfort in 1 case, and obstructive jaundice in 3 cases. Imaging modalities including US, CT, MRI, and ERCP revealed the CBD luminal tumors and biliary dilations in all cases. Surgical procedures were pancreaticoduodenectomy in 4 cases and segmental resection in 2 cases. The survival is relatively good; five patients are now alive, and one died of other disease. Grossly, all the 6 IPC showed intraductal papillary tumors. No mucus was found. Histologically, papillary proliferation of atypical cells with hyperchromatic nuclei regarded as malignant was recognized. The papillary proliferation was accompanied by fine fibrovascular cores in all cases. No stromal invasion was recognized, but lateral non-papillary in situ extension was recognized in 5 cases. Tubular formations were present in some areas in all cases. Goblet cells were present in 5 cases. No mucous hypersecretion was recognized. In one case, the tumor was composed of malignant oncocytes, and was regarded as intraductal oncocytic papillary carcinoma. Immunohistochemically, p53 expression was present in 5 cases, and Ki-67 labeling ranged from 30% to 70%. The author presented clinicopathologic findings of 6 cases of non-invasive IPC of the CBD.

Keywords: Common bile duct; histopathology; intraductal papillary neoplasm.

Figure 1

A: Very low power features of an intraductal papillary carcinoma of the common bile ducts. Two longitudinal sections of common bile duct are demonstrated. A malignant papillary proliferation with fine fibrovascular cores within the common bile duct is recognized. No invasion into the bile duct walls is noted, but lateral non-papillary insitu spreadings were recognized. B: Very low pewer view of another intraductal papillary carcinoma of the common bile duct. Pathologic features are similar to A. C: Low power view highlights the pathologic features of A and B. HE, x10.

Figure 2

Higher power view of the lesion. There werepapillo-tubular proliferations of malignant cells. HE,x200.

Figure 3

Malignant goblet cells are recognized. HE,x 200.

Figure 4

This tumor is composed of malignant oncocyticcells. HE, x200.

Figure 5

The lateral in situ spreading area showsnon-invasive features of tumor cells with flat or micropapillaryconfigurations. The biliary epithelial cellsof the non-tumorous part (left) are desquamated.HE, x200.

Figure 6

p53 protein expression is recognized. Immunostaining,x200.

Figure 7

High Ki-67 labeling is recognized. Immunostaining,x200.