Biliary cystic tumors with bile duct communication: a cystic variant of intraductal papillary neoplasm of the bile duct
Biliary cystic tumors with bile duct communication: a cystic variant of intraductal papillary neoplasm of the bile duct
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DOI：
10.1038/modpathol.3800643
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发表时间：
2006-09-01
期刊：
影响因子：
7.5
通讯作者：
Nakanuma, Yasuni
中科院分区：
文献类型：
--
作者：
Zen, Yoh;Fujii, Takahiko;Nakanuma, Yasuni
胆管囊性肿瘤，也称为胆管囊腺瘤和囊腺癌，被认为是一种异质性疾病实体，其中一些已知显示出与胆管的管腔连通。在这项研究中，我们研究了9例胆管囊性肿瘤与胆管交通的临床病理特征。他们由5名男性和4名女性组成，平均年龄为67岁（52-84岁）。8例为多房性，1例为单房性，均含有粘液性液体。术前或术中胆管造影发现5例与胆管直接管腔连通。本研究中检查的胆管囊性肿瘤的组织学为腺瘤（1例），原位腺癌（6例），腺癌伴微浸润性粘液癌（2例）。1例原位腺癌也有腺瘤成分（腺瘤中的腺癌）。异型增生的粘液上皮在囊内以扁平、微乳头状和乳头状方式增生。在未扩张的邻近胆管内观察到上皮内肿瘤，表明囊性肿瘤和胆管之间有直接的管腔连通。卵巢样间质在任何情况下都没有观察到其壁。免疫组化显示7例肿瘤性胆管上皮表达MUC 1或MUC 2。除1例外，其余病例均存活，术后3-156个月无复发。这些临床病理特征与胆管内乳头状肿瘤相似，后者曾被报道为胰腺导管内乳头状粘液性肿瘤的胆管对应物。总之，胆管囊性肿瘤与胆管交通可以被视为管内乳头状肿瘤与一个突出的囊性扩张的胆管和粘蛋白滞留，而不是真正的胆管囊性肿瘤。
Biliary cystic tumors, which are also called biliary cystadenoma and cystadenocarcinoma, are thought to be a heterogeneous disease entity, and some of them are known to show a luminal communication to the bile duct. In this study, we examined the clinicopathological features of nine cases of biliary cystic tumors with bile duct communication. They were composed of five males and four females with an average age of 67 years (52-84 years). They were multilocular (eight cases) or unilocular (one case), and all cases contained mucinous fluid. A direct luminal communication with the bile ducts was identified in five cases on preoperative or intraoperative cholangiographies. Biliary cystic tumors examined in this study were histologically adenoma (one case), adenocarcinoma in situ (six cases), and adenocarcinoma associated with microinvasive mucinous carcinoma (two cases). One case of adenocarcinoma in situ also had the adenoma component (adenocarcinoma in adenoma). Dysplastic mucinous epithelium proliferated in flat, micropapillary and papillary fashions within the intracystic spaces. Intraepithelial neoplasm was observed within non-dilated adjacent bile ducts, suggesting a direct luminal communication between the cystic tumors and the bile duct. Ovarian-like stroma was not observed in their walls in any cases. Immunohistochemically, seven cases expressed MUC1 or MUC2 in the neoplastic biliary epithelium. All cases except one were alive without any evidences of tumor recurrence after total excision (3-156 months after surgery). These clinicopathological features resembled those of intraductal papillary neoplasm of the bile duct, which had been reported as a biliary counterpart of pancreatic intraductal papillary mucinous neoplasm. In conclusion, biliary cystic tumors with bile duct communication could be regarded as intraductal papillary neoplasm with a prominent cystic dilatation of the bile duct and mucin retention, rather than true biliary cystic neoplasms.