Long-term growth of intrahepatic papillary neoplasms: A case report

• Published in: World journal of gastroenterology : WJG 2019-09, Vol.25 (36), p.5569-5577
• Main Authors: Hasebe, Takumu, Sawada, Koji, Hayashi, Hidemi, Nakajima, Shunsuke, Takahashi, Hiroyuki, Hagiwara, Masahiro, Imai, Koji, Yuzawa, Sayaka, Fujiya, Mikihiro, Furukawa, Hiroyuki, Okumura, Toshikatsu
• Format: Article
• Language: English
• Subjects: Aged; Bile Duct Neoplasms - diagnosis; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Bile Ducts, Intrahepatic - diagnostic imaging; Bile Ducts, Intrahepatic - pathology; Biopsy; Carcinoma, Papillary - diagnosis; Carcinoma, Papillary - pathology; Carcinoma, Papillary - surgery; Case Report; Cholangiography; Cysts - pathology; Cysts - surgery; Hepatectomy; Humans; Male; Middle Aged; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v25.i36.5569

Intraductal papillary neoplasm of the bile duct (IPNB) is a type of tumor that presents in the intra- or extrahepatic bile ducts. Cystic-type intrahepatic IPNB often mimics simple liver cysts, making the diagnosis difficult. Because the growth of IPNB is slow, careful follow-up and timely therapeutic intervention is recommended. There are few reports with a follow-up period longer than a decade; thus, we report the case of a patient with an IPNB that grew for over 13 years. A 65-year-old man was diagnosed, 13 years prior with a cystic hepatic tumor with abnormal imaging findings. The targeted tumor biopsy results showed no malignancy. Biannual follow-up examinations were performed because of the potential for malignancy. The cystic lesions showed gradual enlargement over 11 years and a 4 mm papillary proliferation appeared on the cyst wall, which is compatible with IPNB. The tumor was observed for another 2 years because of the patient's wishes. The imaging findings showed enlargement to 8 mm and a new 9 mm papillary proliferation of the cystic tumor. Contrast-enhanced ultrasonography showed hyperenhancement during the arterial phase in both cyst walls, indicating intraductal tumor progression in both tumors. Thus, liver segment 8 subsegmentectomy was performed. The pathological findings indicated that the tumors contained mucin, and high-grade atypia was observed in the papillary lesions, showing IPNB. The development of IPNB should be monitored in patients with cystic lesions and ultrasonography are useful tool for the evaluation.