A case of intraductal papillary neoplasm of bile duct diagnosed by the biopsy after EST

Abstract

A fifty-year-old woman complaining of back pain and nausea since June 2012 was referred to our hospital. Blood analysis showed high levels of hepatobiliary enzymes and abdominal US identified dilatation of the common bile duct. CT scan and MRCP showed stricture of the lower bile duct by a papillary tumor, while EUS and IDUS images showed a hyper echoic papillary tumor in the lower bile duct. Brushing cytology at the stricture segment of the lower bile duct revealed a class III lesion, so ERCP was repeated. Following observation of the papillary tumor using SpyGlass, a whitish papillary tumor of the lower bile duct was exposed at the papilla of Vater after EST, and biopsy of the tumor was performed. Histological examination showed a tubular adenocarcinoma, and lower bile duct cancer (Stage I) was diagnosed. The patient underwent surgery, and final diagnosis by histology was intraductal papillary neoplasm with an associated invasive carcinoma (IPNB, intestinal type).