Intraductal papillary neoplasm of the bile duct: a single-center retrospective study

Abstract

Objective Intraductal papillary neoplasm of the bile duct (IPNB) has been increasingly recognized and reported. However, its clinical features are still controversial because of its low incidence. In the present study, we investigated the characteristics of IPNB. Methods In total, 28 patients with IPNB were treated at our institution from January 2000 to December 2016. Clinical data were collected and a retrospective accurate database was constructed. Demographic characteristics, perioperative management, and prognosis were retrospectively analyzed. Results Abdominal discomfort was the most common symptom. Preoperative imaging revealed biliary tract dilatation in 23 patients. Left lateral or left hepatic lobectomy was the most frequently performed surgical procedure. Histological analysis revealed malignancy in 17 patients. Eighty-eight lymph nodes were swept from the patients with malignant disease, but only three were metastatic. Twenty-one patients were followed up for 3 to 60 months (mean, 29.4 ± 18.2 months). Seven patients died during the follow-up period. Patients with benign tumors had significantly greater disease-free survival. Conclusions IPNB is a rare biliary disease that occurs mainly in patients of advanced age. The most common symptom is abdominal discomfort. Lymphatic metastasis is uncommon. Patients with benign tumors may have a better prognosis than those with malignant tumors.

Keywords: Intraductal papillary neoplasm of the bile duct; biliary tract; lymph node; rare; survival; treatment.

Figure 1.

Characteristic findings of imaging examinations. (a) Computed tomography showed an intraluminal lesion that originated from the extrahepatic bile duct (arrow). (b) Magnetic resonance imaging revealed extensively dilated bile ducts. (c) Endoscopic ultrasonography showed a hypoechoic occupancy lesion around the bile duct.

Figure 2.

Microscopic histopathology findings. Microscopic histopathology showed the papillary mucinous gland and mild to moderate heteromorphism.

Figure 3.

Kaplan–Meier survival curve for patients with malignant (n = 13) and benign (n = 8) intraductal papillary neoplasm of the bile duct. The test showed a p value of 0.15, which was not statistically significant, but patients with benign tumors had somewhat longer survival. More samples were needed for a more meaningful result.