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Case Reports
. 2024 Nov 12;16(11):e73501.
doi: 10.7759/cureus.73501. eCollection 2024 Nov.

Intraductal Papillary Neoplasm of the Bile Duct Posing Diagnostic and Therapeutic Challenges

Karthik Chalamalasetti  1 , Prabhakaran R  2 , Senthil Kumar P  1 , Sugumar Chidambaranathan  2
Affiliations
Case Reports

Intraductal Papillary Neoplasm of the Bile Duct Posing Diagnostic and Therapeutic Challenges

Karthik Chalamalasetti et al. Cureus. .

Abstract

Intraductal papillary neoplasms of the bile duct are rare tumors with fibrovascular stalks arising from the bile duct. It is often difficult to diagnose preoperatively, especially from mucinous cystic neoplasms. The incidence is more common in Asian countries and rare in Western countries. We report a series of patients with Intraductal papillary neoplasms of the bile duct and describe challenges faced during diagnosis and subsequent management. All the patients differed in clinical and radiological presentation and hence required different approaches to management. The first two cases presented as a space-occupying lesion of the liver, and the third one was a periampullary lesion. All were managed with surgical resection. These neoplasms are uncommon in India and often pose diagnostic and therapeutic difficulties. As the spectrum of presentation varies from benign neoplasm to invasive carcinoma, surgical resection should be performed as it offers the possibility of a cure.

Keywords: bile duct tumour; biliary papillomatosis; intraductal papillary neoplasm of the bile duct; mucinous cystic neoplasm; s: cholangiocarcinoma.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CECT abdomen
(A) Image showing a large cystic lesion (red arrow) in segments 2, 3 and 4 extending to segments 5 and 8 of the liver. (B) The solid components show a significant contrast enhancement (blue arrow). CECT: Contrast-enhancement computed tomography
Figure 2
Figure 2. MRI abdomen
(A) MRI abdomen showing T1 hypointense cystic lesion with papillary excrescences (red arrow). (B) The lesion is hyperintense in the T2 phase with dilatation of the left biliary system (blue arrow). (C) The cyst is compressing the confluence of the right and left hepatic ducts (pink arrow). The dilated common bile duct can also be appreciated (white arrow).
Figure 3
Figure 3. PET/CT scan
The image shows a well-defined cystic lesion in the liver with metabolically active papillary excrescences (red arrow). PET/CT scan: positron emission tomography-computed tomography scan
Figure 4
Figure 4. Operative images
(A) Image after left hepatectomy along with cyst excision, the right anterior portal pedicle can be appreciated (white arrow). (B) Postoperative specimen of the cyst (red arrow) along with resected liver parenchyma.
Figure 5
Figure 5. Postoperative histopathology
(A) Tumor arising from the bile duct (B) High power field showing papillary architecture
Figure 6
Figure 6. MRI abdomen
(A) MRI angiogram in the T1 phase shows a peripherally enhancing hypointense cystic lesion involving segments 6, 7 and 8 of the liver. (B) The lesion is hyperintense in the T2 phase with multiple internal septations (red arrow).
Figure 7
Figure 7. Intraoperative image
Right hepatectomy along with cyst (white arrow) excision.
Figure 8
Figure 8. Postoperative histopathology
(A) Histopathology showing papillary architecture arising from the bile duct. (B) High power field of the tumor
Figure 9
Figure 9. MRI imaging and postoperative histopathology
(A) MRI imaging shows dilated CBD (red arrow) with a soft tissue lesion (white arrow). (B) Another polypoid soft tissue lesion in the distal bile duct can be appreciated (white arrow). (C) Postoperative histopathology shows overlying duodenal mucosa with underlying neoplasm from the bile duct. (D) High-power view of the tumor. CBD: Common bile duct
See this image and copyright information in PMC

References

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