AIM: To gain a better understanding of biliary tract intraductal papillary mucinous neoplasm(BT-IPMN).METHODS: From January 2000 to December 2013, 19cases of BT-IPMN were retrospectively identified from a total of 343...AIM: To gain a better understanding of biliary tract intraductal papillary mucinous neoplasm(BT-IPMN).METHODS: From January 2000 to December 2013, 19cases of BT-IPMN were retrospectively identified from a total of 343 biliary tract tumors resected in our single institution.Demographic characteristics, clinical data, pathology, surgical strategies, and long-term follow-up were analyzed.RESULTS: The mean age of the 19 BT-IPMN cases was 53.8 years(range: 25-74 years).The most common symptom was abdominal pain(15/19; 78.9%), followed by jaundice(7/19; 36.8%).Cholangitis was associated with most(16/19; 84.2%) of the BT-IPMN cases.Macroscopically visible mucin was detected in all 19 patients, based on original surgical reports.The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilation(19/19; 100%) and intraluminal masses(10/19; 52.6%).Thirteen(68.4%) cases involved the intrahepatic bile duct and hilum.We performed left hepatectomy in 11/19(57.9%), right hepatectomy in 2/19(10.5%), bile duct resection in 4/19(21.1%), and pancreatoduodenectomy in 1/19(5.3%) patients.One(5.3%) patient was biopsied and received a choledochojejunostomy because of multiple tumors involving the right extrahepatic and left intrahepatic bile ducts.Histology showed malignancy in 10/19(52.6%) patients.The overall median survival was 68 mo.The benign cases showed a non-significant trend towards improved survival compared to malignant cases(68 mo vs 48 mo, P = 0.347).The patient without tumor resection died of liver failure 22 mo after palliative surgery.CONCLUSION: BT-IPMN is a rare biliary entity.Complete resection of the tumor is associated with good survival, even in patients with malignant disease.展开更多
We present the first case of an intraductal papillary neoplasm of the bile duct(IPNB) accompanying a mixed adenoneuroendocrine carcinoma(MANEC).A 74-yearold woman presented with fever of unknown cause.Laboratory data ...We present the first case of an intraductal papillary neoplasm of the bile duct(IPNB) accompanying a mixed adenoneuroendocrine carcinoma(MANEC).A 74-yearold woman presented with fever of unknown cause.Laboratory data revealed jaundice and liver injury.Contrast-enhanced computed tomography revealed a 20 mm polypoid tumor in the dilated distal bile duct,which exhibited early enhancement and papillary growth.Upper gastrointestinal endoscopy revealed mucus production from the papilla of Vater,characterized by its protruding and dilated orifice.Endoscopic ultrasonography visualized the polypoid tumor in the distal bile duct,but no invasive region was suggested by diagnostic imaging.Therefore,the initial diagnosis was IPNB.After endoscopic nasobiliary drainage,a pylorus-preserving pancreaticoduodenectomy was performed.Pathological examination of the resected bile duct revealed papillary proliferation of biliary-type cells with nuclear atypia,indicating pancreaticobiliary-type IPNB.In addition,solid portions comprised of tumor cells with characteristic salt-and-pepper nuclei were evident.Immunohistochemistry revealed expression of the neuroendocrine marker synaptophysin in this solid component,diagnosing it as a neuroendocrine tumor(NET).Furthermore,the MIB-1 proliferation index of NET was higher than that of IPNB,and microinvasion of the NET component was found,indicating neuroendocrine carcinoma(NET G3).This unique case of MANEC,comprising IPNB and NET,provides insight into the pathogenesis of biliary NET.展开更多
Non-hepatocellular carcinoma （non-HCC） with macroscopic bile duct tumor thrombus （BDTI） formation is rare, few radiological studies have been reported. In this case report, we retrospectively analyzed the imaging ...Non-hepatocellular carcinoma （non-HCC） with macroscopic bile duct tumor thrombus （BDTI） formation is rare, few radiological studies have been reported. In this case report, we retrospectively analyzed the imaging findings of three cases of non-HCC with macroscopic BDTT on dynamic enhanced multislice computed tomography （MSCT） scan. One case of primary hepatic carcinosarcoma was presented as a solitary, large welldefined tumor with significant necrotic changes. One case of liver metastasis from colon cancer was presented as a Iobulated, large ill-defined tumor. One case of intraductal oncocytic papillary neoplasm involved the entire pancreas, presented as a cystic and solid mass with multilocular changes （the individual Ioculi were less than 5.0 mm in diameter）. The bile duct was dilated due to expansible growth of the BDFE in all three patients. The BDTT was contiguous with hepatic or pancreatictumor, and both of them showed the same enhancement patterns on dynamic contrast-enhanced computed tomography scan： early enhancement in the hepatic arterial phase and a quick wash out of contrast agent in the portal and equilibrium phases. Macroscopic BDTT- in non-HCC patient is rare, dynamic enhanced MSCT scan may be valuable in the diagnosis of non-HCC with BDTT.展开更多
Since the first description of intraductal papillary mucinous neoplasms(IPMNs)of the pancreas in the eighties,their identification has dramatically increased in the last decades,hand to hand with the improvements in d...Since the first description of intraductal papillary mucinous neoplasms(IPMNs)of the pancreas in the eighties,their identification has dramatically increased in the last decades,hand to hand with the improvements in diagnostic imaging and sampling techniques for the study of pancreatic diseases.However,the heterogeneity of IPMNs and their malignant potential make difficult the management of these lesions.The objective of this review is to identify the molecular characteristics of IPMNs in order to recognize potential markers for the discrimination of more aggressive IPMNs requiring surgical resection from benign IPMNs that could be observed.We briefly summarize recent research findings on the genetics and epigenetics of intraductal papillary mucinous neoplasms,identifying some genes,molecular mechanisms and cellular signaling pathways correlated to the pathogenesis of IPMNs and their progression to malignancy.The knowledge of molecular biology of IPMNs has impressively developed over the last few years.A great amount of genes functioning as oncogenes or tumor suppressor genes have been identified,in pancreatic juice or in blood or in the samples from the pancreatic resections,but further researches are required to use these informations for clinical intent,in order to better define the natural history of these diseases and to improve their management.展开更多
目的:探讨胰腺实性假乳头状瘤(solid pseudopapillary tumor of pancreas,SPTP)的超声诊断和误诊原因.方法:分析本院2008-06/2011-06经手术、病理证实11例SPTP的超声表现和相关临床资料.结果:11例均为单发圆形或椭圆形、实性或混合性略...目的:探讨胰腺实性假乳头状瘤(solid pseudopapillary tumor of pancreas,SPTP)的超声诊断和误诊原因.方法:分析本院2008-06/2011-06经手术、病理证实11例SPTP的超声表现和相关临床资料.结果:11例均为单发圆形或椭圆形、实性或混合性略低回声团;9例(9/11)边界较清楚,8例(8/11)包膜完整,10例(10/11)瘤后回声无衰减,9例(9/11)相邻组织器官受压、移位;8例(8/11)瘤内及周边可见少许血流信号;除1例胰头SPTP其远端胰管略宽外(0.3cm),其余所有患者胆管、胰管均无扩张.术前超声检查明确诊断5例(5/11);结合年龄、性别、CT高度可疑诊断3例(3/11);因瘤体形态、包膜欠规整,局部增厚或呈分叶状外凸生长,与周围组织界限不清,瘤内结构回声复杂、多样等因素延、误诊3例(3/11).结论:SPTP的超声表现特征为一组"声像图征象群",是超声诊断SPTP的重要线索和可靠指标.其声像图复杂、多样.医师对该疾病缺乏足够的认识是造成延、误诊断的主要原因.展开更多
Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. ...Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. Methods: Thirty-four patients with PTC in isthmus are managed by surgery in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College from 1985-2008. Demographic data, surgical procedures, pathological features, stages and outcomes are analyzed. Results: Seven patients were men and 27 were women. The median age was 41 years (range, 20 - 71). Twenty-five patients were treated with thyroid isthmusectomy or wide field isthmusectomy, five with hemithyroidectomy (lobectomy and isthmusectomy) and four with hemithyroidectomy and partial resection of the contralateral lobe. Twenty-eight patients had a pathologically T1 lesion (pT1);two patients had a pT2 lesion and four had a pT3 lesion. Five patients (14.7%) had papillary carcinoma detected in one of the pretracheal lymph nodes. Thirty-two patients had a solitary lesion confined to the thyroid isthmus. One patient had two lesions in the thyroid isthmus and another one had two lesions located in the thyroid isthmus and right lobe respectively. With a median follow-up of 94 months (range, 12 - 274), two patients had a recurrence and both survived after a re-operation. There was no regional lymph node or distant organ recurrences. No deaths occurred. Conclusions: Isthmusectomy or wide field isthmusectomy could be a sufficient treatment for PTC confined to the thyroid isthmus. We also recommend that pretracheal lymph node dissection be considered.展开更多
BACKGROUND Intraductal papillary neoplasms of the bile duct(IPNBs)are rare and characterized by papillary growth within the bile duct lumen.IPNB is similar to obstructive biliary pathology.In this report,we present an...BACKGROUND Intraductal papillary neoplasms of the bile duct(IPNBs)are rare and characterized by papillary growth within the bile duct lumen.IPNB is similar to obstructive biliary pathology.In this report,we present an unexpected case of asymptomatic IPNB and consolidate our findings with the relevant literature to augment our understanding of this condition.Integrating relevant literature contributes to a more comprehensive understanding of the disease.CASE SUMMARY A 66-year-old Chinese male patient was admitted to our hospital for surgical intervention after gallstones were discovered during a routine physical examination.Preoperative imaging revealed a lesion on the left side of the liver,which raised the suspicion of IPNB.A laparoscopic left hemihepatectomy was performed,and subsequent histopathological examination confirmed the diagnosis of IPNB.At the 3-mo postoperative follow-up,the patient reported good recovery and no metastasis.IPNB can manifest both latently and asymptomatically.Radical surgical resection is the most effective treatment for IPNB.CONCLUSION Hepatic and biliary masses,should be considered to diagnose IPNB.Prompt surgery and vigilant follow-up are crucial in determining prognosis.展开更多
Intraductal papillary mucinous neoplasm of the bile duct(IPNB)is recognized as a precancerous lesion;however,both its pathogenesis and progression remain unclear.We present here a case of IPNB arising from the gallbla...Intraductal papillary mucinous neoplasm of the bile duct(IPNB)is recognized as a precancerous lesion;however,both its pathogenesis and progression remain unclear.We present here a case of IPNB arising from the gallbladder accompanied by bile duct tumor thrombus in a 79-year-old female.The resected specimen revealed a tubulopapillary adenoma with no malignant cells.This case suggests that even in the absence of malignant cells,these tumors can behave as malignant tumors requiring aggressive treatment.Even if no malignant cells are present,intraepithelial neoplasms occurring in the ampullopancreatobiliary tract can behave as malignant tumors.展开更多
基金Supported by The Research Special Fund for Public Welfare Industry of Health,No.201202007
文摘AIM: To gain a better understanding of biliary tract intraductal papillary mucinous neoplasm(BT-IPMN).METHODS: From January 2000 to December 2013, 19cases of BT-IPMN were retrospectively identified from a total of 343 biliary tract tumors resected in our single institution.Demographic characteristics, clinical data, pathology, surgical strategies, and long-term follow-up were analyzed.RESULTS: The mean age of the 19 BT-IPMN cases was 53.8 years(range: 25-74 years).The most common symptom was abdominal pain(15/19; 78.9%), followed by jaundice(7/19; 36.8%).Cholangitis was associated with most(16/19; 84.2%) of the BT-IPMN cases.Macroscopically visible mucin was detected in all 19 patients, based on original surgical reports.The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilation(19/19; 100%) and intraluminal masses(10/19; 52.6%).Thirteen(68.4%) cases involved the intrahepatic bile duct and hilum.We performed left hepatectomy in 11/19(57.9%), right hepatectomy in 2/19(10.5%), bile duct resection in 4/19(21.1%), and pancreatoduodenectomy in 1/19(5.3%) patients.One(5.3%) patient was biopsied and received a choledochojejunostomy because of multiple tumors involving the right extrahepatic and left intrahepatic bile ducts.Histology showed malignancy in 10/19(52.6%) patients.The overall median survival was 68 mo.The benign cases showed a non-significant trend towards improved survival compared to malignant cases(68 mo vs 48 mo, P = 0.347).The patient without tumor resection died of liver failure 22 mo after palliative surgery.CONCLUSION: BT-IPMN is a rare biliary entity.Complete resection of the tumor is associated with good survival, even in patients with malignant disease.
文摘We present the first case of an intraductal papillary neoplasm of the bile duct(IPNB) accompanying a mixed adenoneuroendocrine carcinoma(MANEC).A 74-yearold woman presented with fever of unknown cause.Laboratory data revealed jaundice and liver injury.Contrast-enhanced computed tomography revealed a 20 mm polypoid tumor in the dilated distal bile duct,which exhibited early enhancement and papillary growth.Upper gastrointestinal endoscopy revealed mucus production from the papilla of Vater,characterized by its protruding and dilated orifice.Endoscopic ultrasonography visualized the polypoid tumor in the distal bile duct,but no invasive region was suggested by diagnostic imaging.Therefore,the initial diagnosis was IPNB.After endoscopic nasobiliary drainage,a pylorus-preserving pancreaticoduodenectomy was performed.Pathological examination of the resected bile duct revealed papillary proliferation of biliary-type cells with nuclear atypia,indicating pancreaticobiliary-type IPNB.In addition,solid portions comprised of tumor cells with characteristic salt-and-pepper nuclei were evident.Immunohistochemistry revealed expression of the neuroendocrine marker synaptophysin in this solid component,diagnosing it as a neuroendocrine tumor(NET).Furthermore,the MIB-1 proliferation index of NET was higher than that of IPNB,and microinvasion of the NET component was found,indicating neuroendocrine carcinoma(NET G3).This unique case of MANEC,comprising IPNB and NET,provides insight into the pathogenesis of biliary NET.
文摘Non-hepatocellular carcinoma （non-HCC） with macroscopic bile duct tumor thrombus （BDTI） formation is rare, few radiological studies have been reported. In this case report, we retrospectively analyzed the imaging findings of three cases of non-HCC with macroscopic BDTT on dynamic enhanced multislice computed tomography （MSCT） scan. One case of primary hepatic carcinosarcoma was presented as a solitary, large welldefined tumor with significant necrotic changes. One case of liver metastasis from colon cancer was presented as a Iobulated, large ill-defined tumor. One case of intraductal oncocytic papillary neoplasm involved the entire pancreas, presented as a cystic and solid mass with multilocular changes （the individual Ioculi were less than 5.0 mm in diameter）. The bile duct was dilated due to expansible growth of the BDFE in all three patients. The BDTT was contiguous with hepatic or pancreatictumor, and both of them showed the same enhancement patterns on dynamic contrast-enhanced computed tomography scan： early enhancement in the hepatic arterial phase and a quick wash out of contrast agent in the portal and equilibrium phases. Macroscopic BDTT- in non-HCC patient is rare, dynamic enhanced MSCT scan may be valuable in the diagnosis of non-HCC with BDTT.
文摘Since the first description of intraductal papillary mucinous neoplasms(IPMNs)of the pancreas in the eighties,their identification has dramatically increased in the last decades,hand to hand with the improvements in diagnostic imaging and sampling techniques for the study of pancreatic diseases.However,the heterogeneity of IPMNs and their malignant potential make difficult the management of these lesions.The objective of this review is to identify the molecular characteristics of IPMNs in order to recognize potential markers for the discrimination of more aggressive IPMNs requiring surgical resection from benign IPMNs that could be observed.We briefly summarize recent research findings on the genetics and epigenetics of intraductal papillary mucinous neoplasms,identifying some genes,molecular mechanisms and cellular signaling pathways correlated to the pathogenesis of IPMNs and their progression to malignancy.The knowledge of molecular biology of IPMNs has impressively developed over the last few years.A great amount of genes functioning as oncogenes or tumor suppressor genes have been identified,in pancreatic juice or in blood or in the samples from the pancreatic resections,but further researches are required to use these informations for clinical intent,in order to better define the natural history of these diseases and to improve their management.
文摘目的:探讨胰腺实性假乳头状瘤(solid pseudopapillary tumor of pancreas,SPTP)的超声诊断和误诊原因.方法:分析本院2008-06/2011-06经手术、病理证实11例SPTP的超声表现和相关临床资料.结果:11例均为单发圆形或椭圆形、实性或混合性略低回声团;9例(9/11)边界较清楚,8例(8/11)包膜完整,10例(10/11)瘤后回声无衰减,9例(9/11)相邻组织器官受压、移位;8例(8/11)瘤内及周边可见少许血流信号;除1例胰头SPTP其远端胰管略宽外(0.3cm),其余所有患者胆管、胰管均无扩张.术前超声检查明确诊断5例(5/11);结合年龄、性别、CT高度可疑诊断3例(3/11);因瘤体形态、包膜欠规整,局部增厚或呈分叶状外凸生长,与周围组织界限不清,瘤内结构回声复杂、多样等因素延、误诊3例(3/11).结论:SPTP的超声表现特征为一组"声像图征象群",是超声诊断SPTP的重要线索和可靠指标.其声像图复杂、多样.医师对该疾病缺乏足够的认识是造成延、误诊断的主要原因.
文摘Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. Methods: Thirty-four patients with PTC in isthmus are managed by surgery in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College from 1985-2008. Demographic data, surgical procedures, pathological features, stages and outcomes are analyzed. Results: Seven patients were men and 27 were women. The median age was 41 years (range, 20 - 71). Twenty-five patients were treated with thyroid isthmusectomy or wide field isthmusectomy, five with hemithyroidectomy (lobectomy and isthmusectomy) and four with hemithyroidectomy and partial resection of the contralateral lobe. Twenty-eight patients had a pathologically T1 lesion (pT1);two patients had a pT2 lesion and four had a pT3 lesion. Five patients (14.7%) had papillary carcinoma detected in one of the pretracheal lymph nodes. Thirty-two patients had a solitary lesion confined to the thyroid isthmus. One patient had two lesions in the thyroid isthmus and another one had two lesions located in the thyroid isthmus and right lobe respectively. With a median follow-up of 94 months (range, 12 - 274), two patients had a recurrence and both survived after a re-operation. There was no regional lymph node or distant organ recurrences. No deaths occurred. Conclusions: Isthmusectomy or wide field isthmusectomy could be a sufficient treatment for PTC confined to the thyroid isthmus. We also recommend that pretracheal lymph node dissection be considered.
基金Zhejiang Provincial Natural Science Foundation of China Under Grant,No.LY21H160046.
文摘BACKGROUND Intraductal papillary neoplasms of the bile duct(IPNBs)are rare and characterized by papillary growth within the bile duct lumen.IPNB is similar to obstructive biliary pathology.In this report,we present an unexpected case of asymptomatic IPNB and consolidate our findings with the relevant literature to augment our understanding of this condition.Integrating relevant literature contributes to a more comprehensive understanding of the disease.CASE SUMMARY A 66-year-old Chinese male patient was admitted to our hospital for surgical intervention after gallstones were discovered during a routine physical examination.Preoperative imaging revealed a lesion on the left side of the liver,which raised the suspicion of IPNB.A laparoscopic left hemihepatectomy was performed,and subsequent histopathological examination confirmed the diagnosis of IPNB.At the 3-mo postoperative follow-up,the patient reported good recovery and no metastasis.IPNB can manifest both latently and asymptomatically.Radical surgical resection is the most effective treatment for IPNB.CONCLUSION Hepatic and biliary masses,should be considered to diagnose IPNB.Prompt surgery and vigilant follow-up are crucial in determining prognosis.
基金Supported by Yamamoto Memorial Hospital,Imari City,Saga,Japan
文摘Intraductal papillary mucinous neoplasm of the bile duct(IPNB)is recognized as a precancerous lesion;however,both its pathogenesis and progression remain unclear.We present here a case of IPNB arising from the gallbladder accompanied by bile duct tumor thrombus in a 79-year-old female.The resected specimen revealed a tubulopapillary adenoma with no malignant cells.This case suggests that even in the absence of malignant cells,these tumors can behave as malignant tumors requiring aggressive treatment.Even if no malignant cells are present,intraepithelial neoplasms occurring in the ampullopancreatobiliary tract can behave as malignant tumors.
