A Case of Intraductal Papillary Neoplasm of the Bile duct Diagnosed Using Peroral Cholangioscopy

Abstract

Peroral cholangioscopy (POCS) is usefulness for diagnosing Intraductal papillary neoplasms of the bile duct (IPNB). We report a case of IPNB in which localization of the tumor and histopathological diagnosis were successfully accomplished on POCS. The patient was a 43-year-old woman whose chief complaint was fatigue. She was referred to our hospital because a cystic tumor of the liver had been detected on abdominal ultrasonography. A computed tomographic scan and magnetic resonance imaging showed a cystic tumor (longest diameter, 9 cm) in the left lobe. The tumor was associated with dilatation of the intrahepatic bile duct of the left lobe. Solid components with a contrast effect were seen inside the cystic lesion. Endoscopic retrograde cholangiopancreatography showed a "fish-mouth" sign of the main papilla. Cholangiography revealed a filling defect from the middle bile duct to the left hepatic duct and a cystic area of contrast medium communicating with the left hepatic duct. POCS with narrow-band imaging study showed papillary mucosa in the left hepatic duct, and the bile duct mucosa of the porta hepatis was intact. Lateral spread of IPNB was diagnosed and histologically confirmed by biopsy with POCS.