Abstract
A 73–year–old Japanese women seen in July 2009 for epigastralgia, elevated serum gamma–glutamyltransferase, and a hepatic cystic lesion detected in ultrasonography was found in abdominal dynamic computed tomography (CT) to have a cystic lesion 3 cm in maximum diameter in the left lateral hepatic segment (S3) containing. Two protruding tumors slightly enhanced in early and delayed phases. Magnetic resonance cholangiopancreatography showed the cystic lesion communicating with the intrahepatic bile duct. These findings yielded a preoperative diagnosis of intraductal papillary bile duct neoplasm with cystic bile duct dilation induced by mucin, necessitating limited laparoscopic–assisted liver resection. Grossly, the resected specimen had a markedly dilated bile duct with mucin and a papillary mass protruding into the lumen. Microscopically, tall papillary growth was present in part of the cystically dilated bile duct, with some atypical cells in papillary growth (carcinoma in situ). Tumor cells were immunoreactive for MUC1 and MUC5AC, but not for MUC2 or MUC6. Based on recent criteria, our case corresponds to intraductal papillary mucinous pancreatic neoplasm (pancreaticobiliary type).
