Chia-Hung Wu1,2, Yi-Chen Yeh3,2, Yu-Chuan Tsuei2,4, Li-Kuo Huang2,5, Chia-I Lin6, Chien-An Liu1,2, Hsiou-Shan Tseng1,2, Yi-You Chiou1,2, Nai-Chi Chiu7,8. 1. Department of Radiology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 112, Taiwan, ROC. 2. School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei City, 112, Taiwan, ROC. 3. Department of Pathology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 112, Taiwan, ROC. 4. Department of Orthopaedics, Cheng Hsin General Hospital, No. 45, Zhenxing St., Beitou Dist., Taipei City, 112, Taiwan, ROC. 5. Department of Radiology, National Yang-Ming University Hospital, No.152, Xinmin Rd., Yilan City, 260, Yilan County, Taiwan, ROC. 6. Department of Pathology, Taipei Hospital, Ministry of Health and Welfare, No.127, Su-Yuan Rd., New Taipei City, 242, Taiwan, ROC. 7. Department of Radiology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 112, Taiwan, ROC. dontnike@gmail.com. 8. School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei City, 112, Taiwan, ROC. dontnike@gmail.com.
Abstract
PURPOSE: Biliary tract intraductal tubulopapillary neoplasms (BT-ITPNs) and intraductal papillary mucinous neoplasms (BT-IPMNs) are rare and poorly described. Herein, we examined the magnetic resonance imaging (MRI) features of BT-ITPNs and BT-IPMNs and correlated them with key gross and microscopic pathological findings. METHODS: We retrospectively identified five patients with definitive pathological findings of BT-ITPN and available diagnostic MRI findings. Key MRI features were correlated to the gross and microscopic pathology and compared to those of BT-IPMNs (19 patients). RESULTS: All BT-ITPNs showed ductal dilatation and visible intraductal soft tissue with peribiliary liver parenchyma enhancement. One BT-ITPN patient had synchronous lung metastases, and another showed rapid tumor growth rate. The intraductal soft tissue proportion of BT-ITPNs was significantly more than that of BT-IPMNs (p < 0.05). CA-199 level was elevated in 60% of BT-ITPN cases. The overall combined 1-year and 3-year survival rates in the BT-ITPN group was 100% and 40%, and in the BT-IPMN group was 100% and 58%, respectively. A high intraductal soft tissue proportion, a lack of intraluminal mucin, and immunohistochemical absence of MUC5AC are radiological and pathological characteristics that differentiate BT-ITPN from BT-IPMN. CONCLUSIONS: Although rare, BT-ITPN should be suspected when solid intraductal soft tissue and peribiliary liver parenchyma enhancement are present, particularly if the bile duct upstream and downstream of the lesion have a normal diameter, without mucin. Owing to the aggressive nature of the tumor, recognition of these features may indicate the need for more aggressive treatment in selected patients.
PURPOSE:Biliary tract intraductal tubulopapillary neoplasms (BT-ITPNs) and intraductal papillary mucinous neoplasms (BT-IPMNs) are rare and poorly described. Herein, we examined the magnetic resonance imaging (MRI) features of BT-ITPNs and BT-IPMNs and correlated them with key gross and microscopic pathological findings. METHODS: We retrospectively identified five patients with definitive pathological findings of BT-ITPN and available diagnostic MRI findings. Key MRI features were correlated to the gross and microscopic pathology and compared to those of BT-IPMNs (19 patients). RESULTS: All BT-ITPNs showed ductal dilatation and visible intraductal soft tissue with peribiliary liver parenchyma enhancement. One BT-ITPNpatient had synchronous lung metastases, and another showed rapid tumor growth rate. The intraductal soft tissue proportion of BT-ITPNs was significantly more than that of BT-IPMNs (p < 0.05). CA-199 level was elevated in 60% of BT-ITPN cases. The overall combined 1-year and 3-year survival rates in the BT-ITPN group was 100% and 40%, and in the BT-IPMN group was 100% and 58%, respectively. A high intraductal soft tissue proportion, a lack of intraluminal mucin, and immunohistochemical absence of MUC5AC are radiological and pathological characteristics that differentiate BT-ITPN from BT-IPMN. CONCLUSIONS: Although rare, BT-ITPN should be suspected when solid intraductal soft tissue and peribiliary liver parenchyma enhancement are present, particularly if the bile duct upstream and downstream of the lesion have a normal diameter, without mucin. Owing to the aggressive nature of the tumor, recognition of these features may indicate the need for more aggressive treatment in selected patients.
Entities:
Keywords:
Bile duct; Biliary intraductal papillary mucinous neoplasm; Biliary intraductal tubulopapillary neoplasm; MUC5AC; Magnetic resonance imaging
Authors: Matthew H Lee; Venkata S Katabathina; Meghan G Lubner; Hardik U Shah; Srinivasa R Prasad; Kristina A Matkowskyj; Perry J Pickhardt Journal: Radiographics Date: 2021-10 Impact factor: 6.312