Clinicopathological features of intraductal papillary neoplasms of the bile duct: a comparison with intraductal papillary mucinous neoplasm of the pancreas with reference to subtypes
Intraductal papillary epithelial neoplasms of the pancreatobiliary system (intraductal papillary neoplasm of the bile duct (IPNB) and intraductal papillary mucinous neoplasm (IPMN)) seem to share many clinicopathological features; however, IPNB has not been fully characterized. In order to understand the clinicopathological/immunohistochemical features of IPNB better, we compared 52 cases of IPNB with 42 cases of IPMNs with mural nodules. The IPNB cases were divided into two groups according to their histological similarity and according to five key histological findings. All IPNB and IPMN cases mainly affected middle-aged to elderly people, predominantly men. Mucin hypersecretion was less frequent in IPNB compared to IPMN. Group 2 IPNB more frequently had a higher histopathological grade and more extensive stromal invasion than IPMN. Group 1 IPNB and IPMN were further classified into four subtypes (gastric, intestinal, pancreatobiliary, and oncocytic). Although each subtype of IPNB and IPMN showed similar histology, the immunohistochemical results were different. The gastric type of IPNB was less frequently positive for CDX2, and intestinal IPNB was more frequently positive for MUC1 and less frequently positive for MUC2, MUC5AC, and CDX2 compared to each subtype of IPMN, respectively. In conclusion, IPNB and IPMN have some clinicopathological features in common, but mucin hypersecretion was less frequent both in IPNBs than in IPMN. Group 2 IPNB differed from IPMN in several parameters of tumor aggressiveness. Additional clinicopathological and molecular studies should be performed with respect to the subtypes of IPNB and IPMN.
KeywordsPancreatobiliary system Intraductal papillary neoplasm Mucin secretion Mucus core protein
The authors thank Dr. Katsuhiko Uesaka, Director of the Department of Hepatobiliary Surgery in Shizuoka Cancer Center, for his support on the clinicopathological analysis of biliary tract carcinoma cases in Shizuoka Cancer Center, and also Dr. Jo Matsuoka, Research Support Center, Juntendo University Graduate School of Medicine, Tokyo, Japan, for his advice on statistical methods. The authors also thank Dr. R Wada, Professor of Juntendo Shizuoka Hospital, Department of Clinical Pathology; Dr. N. Tomita, Professor of Juntendo Urayasu Hospital, Department of Clinical Pathology; and Dr. T. Matsumoto, Professor of Juntendo Nerima Hospital, Department of Clinical Pathology, for providing us the opportunity to analyze IPMN cases resected at their hospitals.
Compliance with ethical standards
Institutional review board approval was obtained from Shizuoka Cancer Center.
Conflict of interest
The authors declare that they have no conflict of interest.
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