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Intraductal Tumors of the Biliary Tract: Precursor Lesions and Variants

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Diagnosis and Management of Cholangiocarcinoma

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Abstract

Among the several known intraductal neoplasms of the bile duct, intraductal papillary neoplasm of the bile duct (IPNB) was recently classified as a distinct pathologic entity, which shows grossly exophytic growth in a dilated bile duct lumen, with histologically villous, papillary, or tubular neoplastic epithelia covering fine fibrovascular stalks. While IPNBs are usually a preinvasive lesion, approximately half show stromal invasion (IPNB associated with invasive carcinoma) at the time of surgical resection. IPNBs are pathologically classified into the intestinal, gastric, pancreatobiliary, and oncocytic subtypes. IPNBs were initially graded into low-grade and high-grade dysplasia: recent subclassification of IPNB grades into types 1 (low-grade and high-grade dysplasia with regular architectures) and 2 (high-grade dysplasia with irregular architectures) shows different clinical courses and genetic alterations. Cross-sectional imaging is valuable for delineation of bile duct dilatation and intraductal masses. Cholangiography and cholangioscopy are used to detect mucin hyperproduction, observe the tumor and biliary mucosa, and obtain tissue and cytology samples. Treatment should be considered for all IPNB patients, with surgical resection being the major and most definitive treatment.

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Abbreviations

AUS:

Abdominal ultrasonography

BilIN:

Biliary intraepithelial neoplasm

CA19-9:

Carbohydrate antigen 19-9

CCA:

Cholangiocarcinoma

CEA:

Carcinoembryonic antigen

CT:

Computed tomography

ERC:

Endoscopic retrograde cholangiography

EST:

Endoscopic sphincterotomy

EUS:

Endoscopic ultrasonography

gIPNB:

Gastric intraductal papillary neoplasm of the bile duct

HE staining:

Hematoxylin and eosin staining

iCCA:

Intrahepatic cholangiocarcinoma

ICPN:

Intracholecystic papillary neoplasm

IDUS:

Intraductal ultrasonography

iIPNB:

Intestinal intraductal papillary neoplasm of the bile duct

IPMN:

Intraductal papillary mucinous neoplasm

IPNB:

Intraductal papillary neoplasm of bile duct

ITPN:

Intraductal tubulopapillary neoplasm of the bile duct

MCN:

Mucinous cystic neoplasm

MDCT:

Multidetector computed tomography

MR:

Magnetic resonance imaging

MRC:

Magnetic resonance cholangiography

MUC:

Mucin core protein

NBI:

Narrow-band imaging

oIPNB:

Oncocytic intraductal papillary neoplasm of the bile duct

PanIN:

Pancreatic intraepithelial neoplasm

pbIPNB:

Pancreatobiliary intraductal papillary neoplasm of the bile duct

POCS:

Peroral cholangioscopy

WHO:

World Health Organization

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The authors declare no conflicts of interest in association with the present study.

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Authors and Affiliations

  1. Department of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan

    Yasuni Nakanuma

  2. Department of Diagnostic Pathology, Fukui Prefecture Saiseikai Hospital, Fukui, Japan

    Yasuni Nakanuma

  3. Department of Hepatobiliary Pancreaetic Surgery, Shizuoka Cancer Center, Shizuoka, Japan

    Katsuhiko Uesaka

  4. Department of Hepatobiliary Pancreatic Surgery, Chiba University Hospital, Chiba, Japan

    Masayuki Ohtsuka

  5. Division of Medical Oncology, Cancer Institute, Kanazawa University Hospital, Kanazawa, Japan

    Koushiro Ohtsubo

  6. Department of Radiology, Kanazawa University Hospital, Kanazawa, Japan

    Dai Inoue & Kazuto Kozaka

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  1. Yasuni Nakanuma
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  3. Masayuki Ohtsuka
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  4. Koushiro Ohtsubo
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  1. Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA

    James H. Tabibian

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Nakanuma, Y., Uesaka, K., Ohtsuka, M., Ohtsubo, K., Inoue, D., Kozaka, K. (2021). Intraductal Tumors of the Biliary Tract: Precursor Lesions and Variants. In: Tabibian, J.H. (eds) Diagnosis and Management of Cholangiocarcinoma. Springer, Cham. https://doi.org/10.1007/978-3-030-70936-5_3

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