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Int J Clin Exp Pathol 2012;5(7):690-697

Original Article
Non-invasive intraductal papillary neoplasms of the common bile duct: a
clinicopathologic study of six cases

Tadashi Terada

Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan

Received July 10, 2012; Accepted Augest 5, 2012; Epub September 5, 2012; Published September 15, 2012

Abstract: Recently, several studies of intraductal papillary neoplasms (IPN) of the biliary tracts have been reported in the liver, but there have
been only one study of them in the common bile duct (CBD). The author reviewed 34 archival pathologic materials of surgically resected
specimens containing CBD tumors. Results: Six cases (18%) of IPN of the CBD were found. All cases were non-invasive intraductal papillary
carcinomas (IPC). The age of the patients with IPC ranged from 49 to 77 years with a mean of 67 years. The male to female ratio was 4:2. The
initial symptoms were abdominal pain in 2 cases, abdominal discomfort in 1 case, and obstructive jaundice in 3 cases. Imaging
modalities including US, CT, MRI, and ERCP revealed the CBD luminal tumors and biliary dilations in all cases. Surgical procedures were
pancreaticoduodenectomy in 4 cases and segmental resection in 2 cases. The survival is relatively good; five patients are now alive, and one
died of other disease. Grossly, all the 6 IPC showed intraductal papillary tumors. No mucus was found. Histologically, papillary proliferation of
atypical cells with hyperchromatic nuclei regarded as malignant was recognized. The papillary proliferation was accompanied by fine
fibrovascular cores in all cases. No stromal invasion was recognized, but lateral non-papillary in situ extension was recognized in 5 cases.
Tubular formations were present in some areas in all cases. Goblet cells were present in 5 cases. No mucous hypersecretion was
recognized. In one case, the tumor was composed of malignant oncocytes, and was regarded as intraductal oncocytic papillary carcinoma.
Immunohistochemically, p53 expression was present in 5 cases, and Ki-67 labeling ranged from 30% to 70%. The author presented
clinicopathologic findings of 6 cases of non-invasive IPC of the CBD. (IJCPE12107006).

Keywords: Common bile duct, intraductal papillary neoplasm, histopathology

Address all correspondence to:
Tadashi Terada, MD, PhD
Department of Pathology, Shizuoka City Shimizu Hospital
Shimizu-Ku, Miyakami 1231,
Shizuoka 424-8636, Japan.
Tel: +81-54-336-1111;
Fax: +81-54-336-1315
E-mail: piyo0111jp@yahoo.co.jp