Intraductal papillary mucinous neoplasm of the extrahepatic biliary duct: Report of a case

Volkan Öter, İlter Özer, Murat Ulaş, Tahsin Dalgıç, Tülay Keklik, Erdal Birol Bostancı
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Abstract


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


Keywords


Intraductal papillary mucinous neoplasm, biliary tract, papillary, mucinous

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DOI: http://dx.doi.org/10.7197/cmj.v37i2.5000078102

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