Advertisement

Intraductal papillary neoplasm of the bile duct (IPNB): CT and MRI appearance with radiology-pathology correlation

      Highlights

      • IPNB, a precursor to invasive adenocarcinoma is analogous to pancreatic IPMN, albeit with a higher rate of malignant transformation compared to the latter
      • IPNB's most commonly present as an extrahepatic intraluminal polypoid mass with upstream biliary ductal dilatation, can present as a stricture with plaque like thickening and upstream biliary ductal dilatation and rarely as ductal dilatation without an associated mass
      • IPNB remains a challenging diagnosis as most cases overlap with imaging appearance of Cholangiocarcinoma, hence requiring a multidisciplinary approach for treatment and surveillance

      Abstract

      Purpose

      Intraductal papillary neoplasm of the bile duct (IPNB) is a precursor to invasive carcinoma and is a distinct pathologic diagnosis. The purpose of this study was to evaluate imaging features of IPNB on cross-sectional imaging studies with histopathologic correlation.

      Materials and methods

      In this IRB approved, HIPAA compliant retrospective observational analysis of 23 pathology proven IPNB tumors 22 imaging studies were reviewed, 14 CT and 8 MRI scans. Features evaluated in consensus by two subspecialty-trained abdominal radiologists included: presence of specific lesion/mass within the bile duct, location within the biliary tree, size, morphology, enhancement characteristics, and bile duct caliber.

      Results

      Majority of the subjects (16/18, 90%) had definite intraluminal mass, of which 7 (39%) had a polypoid mass with upstream diffuse biliary ductal dilation and 5 (28%) had a plaque-like mass with focal stricture and upstream biliary ductal dilatation. 6/18 (33%) subjects had low grade dysplasia, most commonly intestinal subtype, 7/18 (39%) subjects presented with invasive component, commonly pancreaticobiliary subtype, and 5/18 (28%) presented with high grade dysplasia.

      Conclusion

      IPNB has increased predilection for extrahepatic bile ducts, commonly presenting as either an intraluminal polypoidal mass with associated upstream biliary ductal dilation or a focal plaque like mass with associated ductal stricture at the site of the tumor.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nagtegaal I.D.
        • et al.
        The 2019 WHO classification of tumours of the digestive system.
        Histopathology. 2020; 76: 182-188
        • Chatterjee A.
        • et al.
        Uncommon intraluminal tumors of the gallbladder and biliary tract: spectrum of imaging appearances.
        Radiographics. 2019; 39: 388-412
        • Wan X.S.
        • et al.
        Intraductal papillary neoplasm of the bile duct.
        World J Gastroenterol. 2013; 19: 8595-8604
        • Ohtsuka M.
        Similarity and differences between intraductal tumors of the bile duct.
        Am J Surg. 2011; 35: 512-521
        • Rocha F.G.
        • Lee H.
        • Katabi N.
        • et al.
        Intraductal neoplasm of bile duct: A biliary equivalent of intraductal papillary neoplasm of pancreas.
        Hepatology. 2012; 56: 1352-1360
        • Park H.J.
        • et al.
        Intraductal papillary neoplasm of the bile duct: clinical, imaging, and pathologic features.
        AJR Am J Roentgenol. 2018; 211: 67-75
        • Lee S.S.
        • et al.
        Clinicopathologic review of 58 patients with biliary papillomatosis.
        Cancer. 2004; 100: 783-793
        • Ying S.
        • et al.
        Morphological classification of intraductal papillary neoplasm of the bile duct.
        Eur Radiol. 2018; 28: 1568-1578
        • Ogawa H.
        • et al.
        CT findings of intraductal papillary neoplasm of the bile duct: assessment with multiphase contrast-enhanced examination using multi-detector CT.
        Clin Radiol. 2012; 67: 224-231
        • Nakanuma Y.
        • et al.
        Tumorigenesis and phenotypic characteristics of mucin-producing bile duct tumors: an immunohistochemical approach.
        J Hepatobiliary Pancreat Sci. 2010; 17: 211-222
        • Kunovsky L.
        • et al.
        Mucinous cystic neoplasm of the liver or intraductal papillary mucinous neoplasm of the bile duct? A case report and a review of literature.
        Ann Hepatol. 2018; 17: 519-524
        • Bennett S.
        • et al.
        Clinical and pathological features of intraductal papillary neoplasm of the biliary tract and gallbladder.
        HPB (Oxford). 2015; 17: 811-818
        • Budzynska A.
        • et al.
        Simultaneous liver mucinous cystic and intraductal papillary mucinous neoplasms of the bile duct: a case report.
        World J Gastroenterol. 2014; 20: 4102-4105
        • Abdelkader A.
        • et al.
        Cystic lesions of the pancreas: differential diagnosis and cytologic-histologic correlation.
        Arch Pathol Lab Med. 2019; 144: 47-61
        • Nakanuma Y.
        • et al.
        Clinicopathological characterization of so-called “cholangiocarcinoma with intraductal papillary growth” with respect to “intraductal papillary neoplasm of bile duct (IPNB)”.
        Int J Clin Exp Pathol. 2014; 7: 3112-3122
        • Nakanuma Y.
        • Kakuda Y.
        • Uesaka K.
        Characterization of intraductal papillary neoplasm of the bile duct with respect to the histopathologic similarities to pancreatic intraductal papillary mucinous neoplasm.
        Gut Liver. 2019; 13: 617-627
        • Wasif N.
        • et al.
        Invasive intraductal papillary mucinous neoplasm versus sporadic pancreatic adenocarcinoma: a stage-matched comparison of outcomes.
        Cancer. 2010; 116: 3369-3377
        • Lee W.J.
        • et al.
        Radiologic spectrum of cholangiocarcinoma: emphasis on unusual manifestations and differential diagnoses.
        Radiographics. 2001; (Spec No): S97-S116
        • Kim S.A.
        • et al.
        Intrahepatic mass-forming cholangiocarcinomas: enhancement patterns at multiphasic CT, with special emphasis on arterial enhancement pattern--correlation with clinicopathologic findings.
        Radiology. 2011; 260: 148-157
        • Ritchie D.J.
        • Okamoto K.
        • White S.L.
        Intraductal papillary mucinous neoplasm of the biliary tract: a precursor lesion to cholangiocarcinoma.
        Radiol Case Rep. 2019; 14: 495-500
        • Matsumoto T.
        • et al.
        Impact of tumor location on postoperative outcome of intraductal papillary neoplasm of the bile duct.
        World J Surg. 2019; 43: 1313-1322