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The clinicopathological spectrum and management of intraductal papillary mucinous neoplasm of the bile duct (IPMN-B).
D'souza, Melroy A; Isaksson, Bengt; Löhr, Matthias; Enochsson, Lars; Swahn, Fredrik; Lundell, Lars; Arnelo, Urban.
Afiliação
  • D'souza MA; Department of Clinical Science, Intervention, and Technology (CLINTEC), Division of Surgery, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden. melroy.dsouza@karolinska.se
Scand J Gastroenterol ; 48(4): 473-9, 2013 Apr.
Article em En | MEDLINE | ID: mdl-23330596
BACKGROUND: Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is a rare but increasingly diagnosed clinical entity. Typical cholangioscopic findings usually include intraductal protruding papillary tumors that secrete mucus. METHODS: Clinical, radiological and histopathological data of seven consecutive patients who were found to have IPMN-B were analyzed. RESULTS: Six of the seven patients presented with obstructive jaundice/cholangitis as the presenting complaint. ERCP and other imaging were equivocal in five of these patients and peroral cholangioscopy (POCS, single-operator cholangioscopy system) was performed. This revealed mucin-producing intraductal tumors with numerous frond-like papillary projections; a macroscopic appearance consistent with IPMN-B. Preoperative biopsy revealed adenoma, with low-grade dysplasia in two patients and high-grade dysplasia in three. Three patients underwent Whipple resection; one underwent total pancreatectomy with left hepatectomy, one patient a pancreas preserving duodenectomy with common bile duct reimplantation and one patient an extended right hepatectomy. These patients were found to have IPMN-B with adenomatous changes with varying grades of dysplasia and even cholangiocarcinoma on final histopathology. One patient first underwent endoscopic papillectomy and on follow-up was found to have cholangiocarcinoma with metastases to the liver. CONCLUSION: POCS can be a key diagnostic investigation in the evaluation of patients with papillary tumors of the bile duct. IPMN-B has a heterogenous pathology and varying grades of dysplasia and even carcinoma may exist in the same patient. Surgical management should be radical and based on tumor extent.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias dos Ductos Biliares / Ductos Biliares Intra-Hepáticos / Adenocarcinoma Papilar / Colangiocarcinoma / Adenocarcinoma Mucinoso / Neoplasias Primárias Múltiplas Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2013 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias dos Ductos Biliares / Ductos Biliares Intra-Hepáticos / Adenocarcinoma Papilar / Colangiocarcinoma / Adenocarcinoma Mucinoso / Neoplasias Primárias Múltiplas Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2013 Tipo de documento: Article