A CASE OF INTRADUCTAL PAPILLARY-MUCINOUS CARCINOMA OF THE BILE DUCT WITH MICROINVASION

Abstract

An asymptomatic 54-year old woman with an elevated biliary enzyme level underwent ultrasonography. It revealed a hyperechoic tumor in the liver Segment 4 and dilation of the left intrahepatic bile duct. A CT scan showed a multilocular cyst in S4 which contained an enhanced mural nodule. On MRI, the cystic tumorous lesion demonstrated a low intensity on T1-weighted imaging and high intensity on T2-weighted imaging. Endoscopic retrograde cholangiography (ERC) revealed a defect localized to the left bile duct. IDUS (Intraductal Ultrasonography) showed a hyperechoic elevated lesion in the left intrahepatic bile duct under the diagnosis of a suspected. Intraductal papillary neoplasm of the bile duct (IPNB) confined to the left lobe of liver, we performed an extended left lobectomy including the caudate lobe, resection of the extrahepatic bile duct, and cholecystectomy. The histopathological findings disclosed microinvasive carcinoma resembling an intraductal papillary mucinous neoplasm with papillary growth in the bile duct. Metastasis to the lymph nodes was not found. There has been no recurrence after surgery for sixteen months.