Trick or Treat: An Intrahepatic Intraductal Papillary Neoplasm of the Bile Duct

Abstract

An intraductal papillary neoplasm involving the biliary tree is an unusual premalignant condition of epithelial origin, identified by its cystic dilatation of the biliary channels. Being a slow-growing tumor, surgery offers the best curative rate, especially in the setting of a low-grade disease. Here, we present a case of a localized, low-grade, intraductal papillary neoplasm of the bile duct (IPNB), residing in the liver, which was treated with resection of the liver lobe. The adjuvant treatment and prognosis highly depend upon the presence of dysplasia or a co-existent invasive malignancy. To the best of our knowledge, being a rare entity, this is the first case to be reported from Pakistan.

Keywords: bile duct; intraductal papillary neoplasm; intrahepatic; low grade; surgical resection.

Figure 1. Contrast-enhanced CT showing a heterogeneous infiltrative area involving the left liver lobe in post-contrast (A) and delayed (B) phases.

Figure 2. Contrast-enhanced MRI showing a focally enhancing lesion in the left liver lobe appearing isointense in the arterial phase (A) and showing diffuse restriction (B).

Figure 3. Contrast-enhanced CT showing metallic suturing at the resection site with internal non-visualization of a previously identified left hepatic lobe lesion.