Intraductal Papillary Neoplasm of the Bile Duct: A Case Report by Jun Lu* in Gastroenterology Medicine & Research_ Gastroenterology Open Access Journals
Abstract
Intraductal
papillary neoplasm of the bile duct (IPN-B) is a rare tumor of the biliary
system that can secrete mucus and is considered to be a precancerous lesion
with high malignant potential, characterized by intraductal growth and easy
recurrence. In this study, a case of IPN-B was reported.
Case Report
On
January 16, 2018, a 76-year-old male patient was admitted due to “upper abdominal
pain and discomfort for over 1 week”. The patient presented with mild
jaundice, no rigor and hyperpyrexia. Laboratory tests: glutamyl transpeptidase
(GGT): 578U/L; alkaline phosphatase (ALP): 149U/L; Total bilirubin:
25.20umol/L; Indirect bilirubin: 20.10umol/L, CA125:8.39U/ ml, CA199:12.99U/ml.
Imaging examination: abdominal enhancement MR & MRCP: nodular abnormal
signal lesion about 1.7 × 1.1cm was observed in the left hepatic duct near the
hepatis porta, and enhancement was observed in the enhanced scan; the upstream
intrahepatic bile duct in the left lobe of the liver was significantly
expanded. Intraoperative findings: The patient underwent left hemi hepatectomy
& cholecystectomy. During the operation, there was free tumor embolus at
the broken end of left hepatic duct. It was decided to perform common bile duct
exploration. The upper segment of common bile duct was incised and removed the
tumor. T-tube drainage was left in place after performing the choledochoscopy. Postoperative
pathology: (left half liver and contents of bile duct cavity) intraductal
papillary neoplasm, high grade, with total lesion area of about 1.1 × 0.7cm.
Liver resection margin, gallbladder neck lymph node (1) and “Group 12” lymph
node (3) showed no tumor. The patient was followed up for over 1 year after the
surgery, without obvious abnormality (Figure 1)
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