Cystic micropapillary neoplasm of peribiliary glands with concomitant perihilar cholangiocarcinoma

• Published in: World journal of gastroenterology : WJG 2016-02, Vol.22 (7), p.2391-2397
• Main Authors: Uchida, Tsuneyuki, Yamamoto, Yusuke, Ito, Takaaki, Okamura, Yukiyasu, Sugiura, Teiichi, Uesaka, Katsuhiko, Nakanuma, Yasuni
• Format: Article
• Language: English
• Subjects: Adenocarcinoma, Papillary - chemistry; Adenocarcinoma, Papillary - diagnostic imaging; Adenocarcinoma, Papillary - pathology; Adenocarcinoma, Papillary - surgery; Aged; Bile Duct Neoplasms - chemistry; Bile Duct Neoplasms - diagnostic imaging; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Biliary Tract Surgical Procedures; Biomarkers, Tumor - analysis; Biopsy; Case Report; Hepatectomy; Hepatic Duct, Common - chemistry; Hepatic Duct, Common - diagnostic imaging; Hepatic Duct, Common - pathology; Hepatic Duct, Common - surgery; Humans; Immunohistochemistry; Klatskin Tumor - chemistry; Klatskin Tumor - diagnostic imaging; Klatskin Tumor - pathology; Klatskin Tumor - surgery; Male; Neoplasms, Cystic, Mucinous, and Serous - chemistry; Neoplasms, Cystic, Mucinous, and Serous - diagnostic imaging; Neoplasms, Cystic, Mucinous, and Serous - pathology; Neoplasms, Cystic, Mucinous, and Serous - surgery; Neoplasms, Multiple Primary; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v22.i7.2391

We report a case of a 75-year-old man with cystic micropapillary neoplasm of peribiliary glands detected preoperatively by radiologic examination. Enhanced computed tomography showed a low-density mass 2.2 cm in diameter in the right hepatic hilum and a cystic lesion around the common hepatic duct. Under a diagnosis of perihilar cholangiocarcinoma, right hepatectomy with caudate lobectomy and bile duct resection were performed. Pathological examination revealed perihilar cholangiocarcinoma mainly involving the right hepatic duct. The cystic lesion was multilocular and covered by columnar lining epithelia exhibiting increased proliferative activity and p53 nuclear expression; it also contained foci of micropapillary and glandular proliferation. Therefore, the lesion was diagnosed as a cystic micropapillary neoplasm of peribiliary glands and resembled flat branch-type intraductal papillary mucinous neoplasm of the pancreas. Histological examination showed the lesion was discontinuous with the perihilar cholangiocarcinoma. Immunohistochemistry showed the cystic neoplasm was strongly positive for MUC6 and that the cholangiocarcinoma was strongly positive for MUC5AC and S100P. These results suggest these two lesions have different origins. This case warrants further study on whether this type of neoplasm is associated with concomitant cholangiocarcinoma as observed in pancreatic intraductal papillary mucinous neoplasm with concomitant pancreatic duct adenocarcinoma.