Öz
SUMMARY
Malignant biliary tract intraductal papillary mucinous neoplasms (BT-IPMN) is a relatively rare disease. A 47-year-old male patient presented with pain and sensitivity on the right upper quadrant of abdomen. Abdominal tomography revealed marked dilatation of the intra-hepatic and extrahepatic bile ducts and polypoid intraluminal mass in the distal extrahepatic bile duct. ERCP was performed and the distal common bile duct brush biopsy was taken. Biopsy revealed IPMN with high grade dysplasia (intraductal papillary mucinous carcinoma in-situ). Patient underwent resection of the extrahepatic bile duct with Roux-en-Y hepaticojejunostomy. Patient was discharged on postoperative seventh day. He has been regularly followed at our outpatient department with no evidence of recurrence. A very rare variant of bile duct carcinoma is distal extrahepatic bile duct papillary neoplasm. Papillary cholangiocarcinoma is believed to show a better prognosis if early detected. It is important to make a precise diagnosis of BT-IPMN and to perform complete surgical resection.
Keywords: Intraductal papillary mucinous neoplasm, biliary tract, papillary, mucinous
ÖZET
Safra kanalının malign intraduktal papiller müsinöz neoplazisi(İPMN) nadir görülen bir hastalıktır. 47 yaşında erkek hasta sağ üst kadran ağrısı ve hassasiyet ile başvurdu. Karın tomografisinde intrahepatik ve ekstrahepatik safra yollarında belirgin genişleme ve ekstrahepatik kanal distalinde lümen içerisinde kitle saptandı. ERCP yapılarak distal ana safra kanalından fırça biyopsi alındı. Biyopsi sonucunda şiddetli displazi odakları içeren İPMN (karsinoma in-situ) saptandı. Hasta ameliyata alınarak ekstrahepatik safra kanalı eksizyonu ve Roux-en-Y hepatikojejunostomi uygulandı. Ameliyat sonrası 7. gün hasta taburcu edildi. Hasta polikliniğimizde düzenli aralıklarla takip edilmekte olup hastalığında tekrarlama gözlenmemiştir. Distal ekstrahepatik safra kanalı kanserleri arasında papiller neoplazi çok nadir görülen bir türdür. Eğer erken saptanırsa iyi prognoz göstereceğine inanılmaktadır. Safra yolu İPMN de erken tanı ve tam cerrahi eksizyon çok önemlidir.
Anahtar sözcükler: İntraduktal papiller müsinöz neoplazi, safra kanalı, papiller, müsinöz
Anahtar Kelimeler
Intraductal papillary mucinous neoplasm biliary tract papillary mucinous
Kaynakça
- Kim HJ, Kim MH, Lee SK, Yoo KS, Park ET, Lim BC. Mucin- hypersecreting bile duct tumor characterized by a striking homol- ogy with an intraductal papillary mucinous tumor (IPMT) of the pancreas. Endoscopy 2000; 32: 389-93.
- Zen Y, Fujii T, Itatsu K, Nakamura K, Minato H, Kasashima S. Biliary papillary tumors share pathologi- cal features with intraductal papil- lary mucinous neoplasm of the pancreas. Hepatology 2006; 44: 1333-43.
- Suzuki A, Suzuki S, Sakaguchi T, Fukumoto K, Ota S, Inaba K. A case of mucin producing cholangi- ocarcinoma arising from the right hepatic duct. (In Japanese with English abstract.) Jpn J Gastroen- terol Surg 2008; 41: 206-11.
- Suh KS, Roh HR, Koh YT, Lee KU, Park YH, Kim SW. Clinico- pathologic features of the intraduc- tal growth type of peripheral chol- angiocarcinoma. Hepatology 2000; 31: 12-7.
- Tajima Y, Kuroki T, Fukuda K, Tsuneoka N, Furui J, Kanematsu T. An intraductal papillary com- ponent is associated with pro- longed survival after hepatic resec- tion for intrahepatic cholangiocar- cinoma. Br J Surg 2004, 91: 99- 104.
- Chen TC, Nakanuma Y, Zen Y, Chan MF, JanYY, Yeh TS. Intra- ductal papillary neoplasia of the liver associated with hepatolithia- sis. Hepatology 2001; 34: 651-8.
- Nakanuma Y, Zen Y, Harada K, Ikeda H, Sato Y, Uehara T. Tu- morigenesis and phenotypic char- acteristics of mucin-producing bile duct tumors: An immunohisto- chemical approach. J Hepatobili- ary Pancreat Sci 2010; 17: 211-22.
- Bosman FT, Carneiro F, Hruban RH, eds. WHO Classification of Tumours of the Digestive System. World Health Organization Classi- fication of Tumours. Lyon, France: IARC 2010.
- Barton JG, Barrett DA, Maricevich MA, Schnelldorfer T, Wood CM, Smyrk TC. Intraductal papillary mucinous neoplasm of the biliary tract: A real disease? HPB (Ox- ford) 2009; 11: 684-91.
- Yeh CN, Jan YY, Yeh TS, Hwang TL, Chen MF. Hepatic resection of the intraductal papillary type of peripheral Ann Surg Oncol 2004; 11: 606-11.
- Güllüoğlu MG, Ozden I, Poyanlı A, Cevikbas U, Arioglu O. Intra- ductal producing peripheral cholangio- carcinoma associated with biliary papillomatosis. Ann Diagn Pathol 2007; 11: 34-8. mucin
- Zen Y, Sasaki M, Fujii T, Chen TC, Chen MF, Yeh TS. Different expression patterns of mucin core proteins and cytokeratins during intrahepatic cholangiocarcinogen- esis from biliary intraepithelial ne- oplasia and intraductal papillary neoplasm of the bile ductan im- munohistochemical study of 110 cases of hepatolithiasis. J Hepatol 2006; 44: 350-8.
- Rocha FG, Lee H, Katabi N, Dematteo RP, Fong Y, D’Angelica MI. Intraductal papillary neoplasm of the bile duct: A biliary equiva- lent to intraductal papillary mucin- ous neoplasm of the pancreas? Hepatology 2012; 56: 1352-6.
- Shibahara H, Tamada S, Goto M, Oda K, Nagino M, Nagasaka T. Pathologic features of mucin- producing bile duct tumors: Two histopathologic categories as coun- terparts of pancreatic intraductal papillary-mucinous Am J Surg Pathol 2004; 28: 327- 38. neoplasms.
- Kloppel G, Kosmahl M. Is the in- traductal papillary mucinous neo- plasia of the biliary tract a coun- terpart of pancreatic papillary mu- cinous neoplasm? J Hepatol 2006; 44: 249-50.
- Ji Y, Fan J, Zhou J, Wang BS, Liu HB, Wu ZW, Tan YS. Intraductal papillary neoplasms of bile duct. A distinct entity like its counterpart in pancreas. Histol Histopathol 2008; 23: 41-50.
- Chen MF, Jan YY, Chen TC. Clin- ical studies of mucin-producing cholangiocellular carcinoma: A study of 22 histopathologyproven cases. Ann Surg 1998; 227: 63-9.
- Yeh TS, Tseng JH, Chen TC, Liu NJ, Chiu CT, Jan YY. Characteri- zation of intrahepatic cholangio- carcinoma growth-type and its precursor le- sions. Hepatology 2005; 42:657- 64. intraductal
- Yeh TS, Tseng JH, Chiu CT, Liu NJ, Chen TC, Jan YY. Cholangio- graphic spectrum of intraductal papillary mucinous neoplasm of the bile ducts. Ann Surg 2006; 244: 248-53.
Öz
Safra kanalının malign intraduktal papiller müsinöz neoplazisi(İPMN) nadir görülen bir hastalıktır. 47 yaşında erkek hasta sağ üst kadran ağrısı ve hassasiyet ile başvurdu. Karın tomografisinde intrahepatik ve ekstrahepatik safra yollarında belirgin genişleme ve ekstrahepatik kanal distalinde lümen içerisinde kitle saptandı. ERCP yapılarak distal ana safra kanalından fırça biyopsi alındı. Biyopsi sonucunda şiddetli displazi odakları içeren İPMN (karsinoma in-situ) saptandı. Hasta ameliyata alınarak ekstrahepatik safra kanalı eksizyonu ve Roux-en-Y hepatikojejunostomi uygulandı. Ameliyat sonrası 7. gün hasta taburcu edildi. Hasta polikliniğimizde düzenli aralıklarla takip edilmekte olup hastalığında tekrarlama gözlenmemiştir. Distal ekstrahepatik safra kanalı kanserleri arasında papiller neoplazi çok nadir görülen bir türdür. Eğer erken saptanırsa iyi prognoz göstereceğine inanılmaktadır. Safra yolu İPMN de erken tanı ve tam cerrahi eksizyon çok önemlidir
Anahtar Kelimeler
İntraduktal papiller müsinöz neoplazi safra kanalı papiller müsinöz
Kaynakça
- Kim HJ, Kim MH, Lee SK, Yoo KS, Park ET, Lim BC. Mucin- hypersecreting bile duct tumor characterized by a striking homol- ogy with an intraductal papillary mucinous tumor (IPMT) of the pancreas. Endoscopy 2000; 32: 389-93.
- Zen Y, Fujii T, Itatsu K, Nakamura K, Minato H, Kasashima S. Biliary papillary tumors share pathologi- cal features with intraductal papil- lary mucinous neoplasm of the pancreas. Hepatology 2006; 44: 1333-43.
- Suzuki A, Suzuki S, Sakaguchi T, Fukumoto K, Ota S, Inaba K. A case of mucin producing cholangi- ocarcinoma arising from the right hepatic duct. (In Japanese with English abstract.) Jpn J Gastroen- terol Surg 2008; 41: 206-11.
- Suh KS, Roh HR, Koh YT, Lee KU, Park YH, Kim SW. Clinico- pathologic features of the intraduc- tal growth type of peripheral chol- angiocarcinoma. Hepatology 2000; 31: 12-7.
- Tajima Y, Kuroki T, Fukuda K, Tsuneoka N, Furui J, Kanematsu T. An intraductal papillary com- ponent is associated with pro- longed survival after hepatic resec- tion for intrahepatic cholangiocar- cinoma. Br J Surg 2004, 91: 99- 104.
- Chen TC, Nakanuma Y, Zen Y, Chan MF, JanYY, Yeh TS. Intra- ductal papillary neoplasia of the liver associated with hepatolithia- sis. Hepatology 2001; 34: 651-8.
- Nakanuma Y, Zen Y, Harada K, Ikeda H, Sato Y, Uehara T. Tu- morigenesis and phenotypic char- acteristics of mucin-producing bile duct tumors: An immunohisto- chemical approach. J Hepatobili- ary Pancreat Sci 2010; 17: 211-22.
- Bosman FT, Carneiro F, Hruban RH, eds. WHO Classification of Tumours of the Digestive System. World Health Organization Classi- fication of Tumours. Lyon, France: IARC 2010.
- Barton JG, Barrett DA, Maricevich MA, Schnelldorfer T, Wood CM, Smyrk TC. Intraductal papillary mucinous neoplasm of the biliary tract: A real disease? HPB (Ox- ford) 2009; 11: 684-91.
- Yeh CN, Jan YY, Yeh TS, Hwang TL, Chen MF. Hepatic resection of the intraductal papillary type of peripheral Ann Surg Oncol 2004; 11: 606-11.
- Güllüoğlu MG, Ozden I, Poyanlı A, Cevikbas U, Arioglu O. Intra- ductal producing peripheral cholangio- carcinoma associated with biliary papillomatosis. Ann Diagn Pathol 2007; 11: 34-8. mucin
- Zen Y, Sasaki M, Fujii T, Chen TC, Chen MF, Yeh TS. Different expression patterns of mucin core proteins and cytokeratins during intrahepatic cholangiocarcinogen- esis from biliary intraepithelial ne- oplasia and intraductal papillary neoplasm of the bile ductan im- munohistochemical study of 110 cases of hepatolithiasis. J Hepatol 2006; 44: 350-8.
- Rocha FG, Lee H, Katabi N, Dematteo RP, Fong Y, D’Angelica MI. Intraductal papillary neoplasm of the bile duct: A biliary equiva- lent to intraductal papillary mucin- ous neoplasm of the pancreas? Hepatology 2012; 56: 1352-6.
- Shibahara H, Tamada S, Goto M, Oda K, Nagino M, Nagasaka T. Pathologic features of mucin- producing bile duct tumors: Two histopathologic categories as coun- terparts of pancreatic intraductal papillary-mucinous Am J Surg Pathol 2004; 28: 327- 38. neoplasms.
- Kloppel G, Kosmahl M. Is the in- traductal papillary mucinous neo- plasia of the biliary tract a coun- terpart of pancreatic papillary mu- cinous neoplasm? J Hepatol 2006; 44: 249-50.
- Ji Y, Fan J, Zhou J, Wang BS, Liu HB, Wu ZW, Tan YS. Intraductal papillary neoplasms of bile duct. A distinct entity like its counterpart in pancreas. Histol Histopathol 2008; 23: 41-50.
- Chen MF, Jan YY, Chen TC. Clin- ical studies of mucin-producing cholangiocellular carcinoma: A study of 22 histopathologyproven cases. Ann Surg 1998; 227: 63-9.
- Yeh TS, Tseng JH, Chen TC, Liu NJ, Chiu CT, Jan YY. Characteri- zation of intrahepatic cholangio- carcinoma growth-type and its precursor le- sions. Hepatology 2005; 42:657- 64. intraductal
- Yeh TS, Tseng JH, Chiu CT, Liu NJ, Chen TC, Jan YY. Cholangio- graphic spectrum of intraductal papillary mucinous neoplasm of the bile ducts. Ann Surg 2006; 244: 248-53.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Temmuz 2015 |
| Yayımlandığı Sayı | Yıl 2015 |