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WbrI″ ノOsf′ りたЮ72014 July l七 20(26):8736‑8鷺 9

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DOI:10.3748/wig.V20。 i26。 8736

TubulopapIIIary adenoma of the ga‖ bladder accompanied
by bile duct tumor thrombus
Kentaroh Yamamoto′ Fumio Yamamoto′ Atsuhiro Maeda′ Hirotsune lgimi′ Mami Yamamoto′
RyOsuke Yamaguchi′ Yuichi Yamashita
Kentaroh Yamamoto′ Furnio Yamamoto′ Hirotsune lgirni′
Mami Yamamoto′ IDepartment of Surgery9 Yamamoto lMlemorialc)2014 Baishideng Publishing Group lnc.A‖ rights reserved.

Hospital,Saga 848‐ 0031,Japan

Key words:Intraductal papi‖ ary mucinous neoplasrn ofAtsuhiro Maeda′ DepaЁInent oflnternal Medicine,Miaeda Hos―pital,Saga 848‑0031,Japanthe bile ducti ttumor thrombi

RyOsuke Yamaguchi′ Yuichi Yamashita′ E)epartⅡlent of G}as‐
troenterological Surge理 ソ,Fukuoka University School of)√edi―

cine,Fukuoka 814‑0180,Japan
Author contttbuUons:Yamamoto K,Yantamoto F and Yamashi…

Core tip:Intraductal pap‖ lary mucinous neoplasm of
the bile duct(IPNB)has relauvely recendy been rec―Hl perfЭ nned the genetic analyses;Yamamoto K,Mlaeda A andognized as a separate disease entity with an unclear
pathogenesis日 ｀Ve present a case of IPNB developing
frorn the ga‖ bladder accompanied by a bile duct tumor

ta Y designed tlle report;Yamamoto K,Yalllal■

oto M and lgillli

Yalllaguchi R conected the patient's clinical data;Yamamoto K

thrombus in a 79口 year― old femaleB Aithough this is notanalyzed the data and、vrote the papen

a malignant lesion′

Supported by Yamamoto Memorial Hospital,Imtti City.Saga,

lignant lesion′ and hence needs aggressive treatrnenti

it has the potential to mirnic a ma‐

Japan

Correspondence to:Kentaroh Yamamoto′ MD′ PhD′ Department of Surgery9 Yamamoto lMenlorial Hospital,Hachiyakara■ li
88… 4,Niri― chO,IInari,Saga 848‑0031,
Japan.kentaroh… y@kettin kai.COm

Yamamoto lK,Yamallloto F,Mlaeda A,Igimi HI,Yamamoto MI,
Y TLlbu10papillary adenoma of theYal■ lagLIChi R,ゞ amashita

gallbladder accompanied by bile duct tumor thrombus.

丁elephone:+81‑955‑232166 Fax:+81‐ 955‥ 224702

Received:Januat/7,2014

Gα ∫″りθ′たハθノ2014;20(26):8736‑8739 Available fl・Revised:January 31,2014

澪s/ム ノノ

om:URL:httpノ /www.vttgnet.COm/1007… 9327/ful1/v20/126/8736.htm DOI:

Accepted:卜√arch 6,2014

可g.v20.i26.8736

Published onlinel July 14,2014

llttp:〃 dx.doi.org/10.3748′

AbsfracI

INTRODUCT10N

Intraductal pap‖ lary mucinous neoplasnl of the bile

Intraductal pap」 ary lnucinous neoplasin cPLIN)of theble duct(IPINB)is a diSCase cntiち r thatヽ 砲
S propOsed in
11.IPNB is rcgardcd as a cOuntcrpart

duCt(IPNB)is reCOgnized as a precancerous lesioni

2001 by Chcn′ ノノ′however′ both its pathogenesis and progression remain

unclear.llVe present here a case of IPNB arising fromthe ga‖ bladder accompanied by b‖ e duct tumor throm―of IP卜 11ゞ Of thc pancreas,and is cOl■ sidcrcd tO bc a pre…
canccrous lcsiOn12‐ 到.ノ 、 sil■ ■ilar spcctrugl of lcsiOns also

bus in a 79‑year‐ old female. The resected specirnen

cxists in thc gallbladdcr161.H。 、revcr,thcsc lcsiOns havc

revealed a tubulopapillary adenoma with no malignantce‖ s.丁 his case suggests that even in the absence ofyet to bc ftllけ characterized and their pathogenesis andprogressiOn■ crrlain unclcaro MOst repo■ ted cases of in―ma‖ gnant cells′ these tumors can behave as malignant
tumors requiring aggressive treatrllent. Even if no ma―
gnant ce‖ s are present′ intraepitheliai neoplasms oc―‖

平 s市 c IPNB ultimatcけ become cancerous.GenerallB thecurring in the ampu‖ opancreatobiliary tract can behave
as rnalignant tumors.

out canccFOuS Changcs accompanicd by a bilc duct tumor
thrOmbus.

∬¨

WJG I wwwoWigl■ et・ COmtumors accompanicd by a bile duct tumor thrOmbus arc

canccrous.Hcrc、 re rcport a rarc gallbladdcr tumOr宙 th―

8736

July 14′ 2014 i Volu]me 20 1 1ssue 26 1

Yamamoto K θ′∂/E Adenoma ofthe ga‖ bladderFigure l A 79・ year・ old female presented to our hospitalfor an incidenta‖y・diagnosed ga‖ bladdertumor.Ai Coronal contrast‐ enhanced computed tomography
p lnfuslon cholanglographlc Ctt image.The white arrow in‐(CT)lmagel The whlte arrow polnts to the gallbladder tumor wlth blle duct tumor thrombusl Bi Coronal d‖dlcates the gallbladder tumor wlth blle duct tumor thrombusi Ci Endoscoplc retrograde cholanglopancreatography imagei tthe white arrow indicates the defect due tohe whlte arrow lndlcates the defect due to the blle ducttumorthrombusi

the bile ducttumorthrombus:D:MagneJc resonance cholangiopancreatography image.丁20U/mL(0‑50U/mLl;lactatc dch57drogenasc,170Uメ L(106‑21l U/Ll;albumin,4。 Og/dL(3.7‑5。 5g/dLl;andtOtal bihrubin,0。 64g/dL(0.2‑1.Og/dLl.Thc COncentra―
tions of carcinOembryonic antigcn and carbohydrate an―tigen 19‑9 Wcrc 2。 2 ng/mL(<5。 O ng/mLl and 4。

OU/mL(<37.OU/mLl,rcsPCCtiVCtt No serological e宙dencc ofhepatitis B or C was secn.

Contrast enhanccd coELputed tolnography(CT)rcvcalcd a tumOr ineasuring 40 1nrn in diametcr in thecystic duct,accompanied by a conllnon bile duct tumor

throlnbus(Figurc lA).Drip infusion cholangiographic
CT rcvcaled a defect in the common bile duct(FigurclB)0]M[agnctic resonancc cholangiopancreatography andcndoscopic rctrOgradc ch01angiopancrcatography rc―
vealed similar ttndings cigurC lC and D)。

CytO10gical ex―

anlination rcvcaled thc abscncc of inalignant cells in bile。

Without thc cvidence of inalignant cens,wc diagnOscd it
as gallbladdcr cancer or bilc duct cancer becausc of thc

Figure 2 The resected specirneni Dissectlon ofthe common blle duct demon¨
produclng tumorthrombus,

strated a mucln‐

colninon bile duct ttllnOr thrombus.

CASE REPORT

lecystectomy卜 [acroscopic cxanlination of thc resectcd
SPCCilncn rcvcaled a 40‑1「 lln tumor locatcd in the ncck

The paticnt undcrwcnt cholcdochcctomy and ChO―

Of thc galbladder and a 30‑inln tumor thrombus in the

A79‑year― old fclnale presentcd to Our hospital for an in―cidentally― diagnoscd gallbladderり mOrO No abnormahdes
were scen in blood test results,inこ luding tumor rnarkcrs.

common bilc,宙 th rich mucilagc cigurC 21.lWiCroscopi…
callb hcmatoxylin and cosin staining demonstratcd thc
tumor to be a pyloric type tubulopapillary adcnoma vrith
mOdcratc epithelial atypia,vrithout cvidencc of stromal

Laboratory data lnOrmal range)were aS f01lows:aspartateダ¨aminotransfcrasc,18U/L(5‑35U/Ll;alaninc amino―transferasc,14U/L(5‑30U/Ll;alkaline phosphatase,
151U/L(115‑359U/Ll;gamma̲glutamyl transferase,

WJG I wwwoWignetoCOm

invasion(Figurc 3)。

On immun。 logical staining,thc tu―

mor cells wcrc posit市 e for MUC5AC,but negat市 c fOr

8737

July 14′ 2014 i Volu]me 20 1 1ssue 26 1

Yamamoto K θ′∂ Adenoma ofthe ga‖ bladder/ョ

Figure 3 Pathological examination ofthe tumori A:Hematoxylln and eosln stalning demonstrated the tumorto be a tubulopaplllary adenoma with moderate epithe¨‖
al atypia(× 400)iB:M∪ C5AC staining showlng posltlve expresslon(× 600),

MUCl and CIC20。

panled by bile ducttumorthrombusi

DISCUSSION

The patlent was dlagnosed wlth gallbladder carclnoma by the imaging study,

Cllinicar dliag″

osたDlifferenfiar dliagnOsた
Dlferentlal dlagnoses were blle duct carclnoma invaded to the gallbladder,ma‐

Rccentltt intracPithClial ncOplaslに ls oCcurring in the anl̲￨lgnantlymphoma and lntraductal paplllary muclnous neoplasm ofthe blle duct,

pullopancreatObiliary tract havc attractcd a substantial

Laわ orarory diagnOsたamount Of attcntion.Thcsc include the sO̲callcd IPNB,

AIl ofthe laboratory tests were withln normal‖ mlts,

IP■N/1N of the pancrcas,intraductal tubu10papillary ncO̲rmagttg diag″ osた

plasms(ITPN)of thC pancrcas,intra̲ampullary̲tubular

Computed tomography revealed a tumor measuttng 40 mm ln diameterln thecystlc duct,accompanied by a common blle ducttumorthrombus,Dttp lnfuslon;写 鸞 翻

跳

晶

I薫 罫

震町

:調 器

鵠

cholanglographlc‐ computed lomography,magnetic resonance lmaglng,endo¨scoplc retrograde cholangiopancreatography revealed a defect ln the common

arc rccOgnizcd by thc LVOrld]Hcalth C)rganizatiOn171.

b‖ e

IPNB,on thc Othcr hand,is a relauvely reccntly proposcd

duct.

Pa詢 o′ogた ar dliag4osた

11]whiCh has bcen shOurn tO bc his̲lin 2001)diSCase cntiサ
tologically similar tO IPMNpも
A similar spectrum of le―

Cytologlcal examlnatlon revealed the absence of mallgnant cells in blle,Mlcro…

￨。

scoplca‖ y,resected specimen revealed a pylorlc type tubulopap‖ lary adenoma、

sions alsO cxistsin IAPN and ICPN;howcver,thesc havc

wlth moderate epithellal atypia,

not becn fully charactcrizcd[61.

Trearme″ f

IPNBs arc histO10gicalヶ claSS五 Cd as low̲Or intermc―

丁he patlent underwent choledochectomy and cholecystectomy.

Rerared reporrs

diatc― gradc intracPithClial ncoplasia cOrrcspOnding to ade―nomas or bOrdcrhnc mahgnanctt high gradc intracPithChal

lntraductal pap‖

lary mucinous neoplasms ofthe b‖ e duct are hlslologlca‖

y clas‐sified as loⅥ ルor intermediate¨ grade lntraepithe‖ al neoplasla correspondlng lo

I壇

1麗r記 常 i農 篤 静

adenomas or borderllne ma‖ gnancy,hlgh grade intraeplthe‖

al neoplasia corre…

貫雀
L:ittr舞 :regardcd as prccancerOus lcsiOns;thcrcfOre,radical rescc̲

丁he neoplasms accompanled wlth tumor thrombus are olen ordlnary invasivetion is rccOnlinendcd in Opcrablc PatiCnts‖ '5,8,鋼

carclnoma.

.

spondlng lo carcinoma lin s〃 υ,or as havlng an assoclated lnvaslve carclnoma.

Term expra″ arliOn

In Our casc,although thc epithclial a句 4)ia vzas rnodcr̲

ate,it was accompanied by a bile duct tumOr thrombus.

lntraductal pap‖ lary muclnous neoplasm ofthe b‖

The ncOplasins accompanicd、 ァ
ith tumOr thrombus are

nized dlsease entlty whose behavloris stlll unclearie duct ls a recently recog‐

Experliences ard ressons

Oftcn Ordinary invasivc carcinoma110'1 ll.what is curiOus
is that nO symptOlns of biliary tract obstructiOn uzcrc

Although the epithellal atypia was moderate,lt was accompanled by a blle duct

tumor thrombus,Even lf no mallgnant cells are present,lntraeplthellal neo‐

obscrvcd in Our paticnt,althOugh wc cannot rulc Out thc

plasms occuttng in the ampullopancreatoblllary tract can behave as malignant

possibility that such symptolTIs cOuld have occurred intumorsi Hence,these patients should be treated aggresslvely,

the ilYlmediate futurco Furthermore,it is rcportcd that py―

Peer reyrew

loric wpc adCnOcarcinoma of thc gallbladdcr has a poor

丁hls artlcle applies the validlty of surglcal treatment for lntraepithellal neoplasms
occurrlng ln the ampu‖ opancreatob‖ lary tract,even lfltis an adenoma=

prognosis11劉 .SO,in Our casc,surgical trcatmcnt is cOnsid̲

ered rcasOnablc and prOper.

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Reviewer:ン Vang DS S― Editor:GouSX L"Editor:ν Vang TQ
E"Editor:ツ Vang CH

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WJG l www.■ rignetoCOm8739

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