Biliary Cystic Tumors: Clinicopathological Features
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Several types of biliary cystic tumors or tumorous lesions have been reported (Nakanuma et al., 2000; Portman and Nakanuma, 2006). Currently, with advanced imaging techniques, increasing numbers of cystic diseases including rare types are being found, and their clinicopathological features are now being characterized (Okuda, 2001). Hepatobiliary cystadenoma and cystadenocarcinoma are a prototype of biliary cystic tumors, and intraductal papillary neoplasm of the bile duct, particularly with cystic dilatation, is a recently proposed disease entity (Chen et al., 2001). However, the exact definition and clinicopathological features of these biliary cystic tumors, particularly for differential diagnosis, remain to be established because the number of cases is small. While the cystic lesions themselves are rather easily detectable by imaging modalities, an exact diagnosis based on pathological characteristics is needed at present.
In this chapter, the clinicopathological features of biliary cystic tumors, such as their walls being lined by biliary or other epithelial cells, are reviewed. The tumors can be divided into non-neoplastic and neoplastic categories. The former includes hamartomatous lesions or developmental anomalies. Recently, diagnostic criteria for intraductal papillary mucinous neoplasm (IPMN) and mucinous cystadenoma and cystadeno-carcinoma, which are also called mucinous cystic neoplasm of the pancreas (pancreatic MCN), have been established with reference to the presence of communication with the duct system and also the presence of ovarian-like stroma in the cystic walls (Longnecker et al., 2000; Zamboni et al., 2000). Recent studies showed that two similar types of neoplastic diseases are also present in the hepatobiliary system (Chen et al., 2001; Zen et al., 2006b; Abraham et al., 2002, 2003). In this review, these biliary cystic tumors are discussed and compared with pancreatic cystic tumors from the standpoint of their clinicopathological similarities. Solitary hepatic cyst, polycystic liver, and cystic dilatation of the bile duct will not be discussed here.
KeywordsBile Duct Extrahepatic Bile Duct Compute Tomography Peribiliary Gland Intraductal Papillary Neoplasm
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- Adbores-Saavedra, J., Scoazec, J.C., Wittekind, C., Sripa, B., Menck, H.R., Soehendra, N., and Sriram, P.V.J. 2000. Carcinoma of the gallbladder and extrahepatic bile ducts. In: Hamilton, S.R., Aaltonen, L.A., eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System. Lyon: IARC Press, 207–214.Google Scholar
- Chen, T.C., Nakanuma, Y., Zen, Y., Chen, M.F., Jan, Y.Y., Yeh, T.S., Chiu, C.T., Kuo, T.T., Kamiya, J., Oda, K., Hamaguchi, M., Ohno, Y., Hsieh, L.L., and Nimura, Y. 2001. Intraductal papillary neoplasia of the liver associated with hepatolithiasis. Hepatology 34: 651–658.PubMedCrossRefGoogle Scholar
- DeHaan, R.D., Kipp, B.R., Smyrk, T.C., Abraham, S.C., Roberts, L.R., and Halling, K.C. 2007. An assessment of chromosomal alterations detected by fluorescence in situ hybridization and p16 expression in sporadic and primary sclerosing cholangitis-associated cholangiocarcinomas. Hum. Pathol. 38: 491–499.PubMedCrossRefGoogle Scholar
- Ishikawa, A., Sasaki, M., Ohira, S., Ohta, T., Oda, K., Nimura, Y., Chen, M.F., Jan, Y.Y., Yeh, T.S., and Nakanuma, Y. 2004a. Aberrant expression of CDX2 is closely related to the intestinal metaplasia and MUC2 expression in intraductal papillary neoplasm of the liver in hepatolithiasis. Lab. Invest. 84: 629–638.CrossRefGoogle Scholar
- Ishikawa, A., Sasaki, M., Sato, Y., Ohira, S., Chen, M.F., Huang, S.F., Oda, K., Nimura, Y., and Nakanuma, Y. 2004b. Frequent p16ink4a inac-tivation is an early and frequent event of intraductal papillary neoplasm of the liver arising in hepatolithiasis. Hum. Pathol. 35: 1505–1514.CrossRefGoogle Scholar
- Longnecker, D.S., Hruban, R.H., Adler, G., and Kloppel, G. 2000. Intraductal papillary-mucinous neoplasms of the pancreas. In: Hamilton, S.R., Aaltonen, L.A., eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System. Lyon: IARC Press, 237–240.Google Scholar
- Nakanuma, Y., Leong, A.S.Y., Sripa, B., Ponchon, T., Vatanasapt, V., and Ishak, K.G. 2000. Intrahepatic cholangiocarcinoma. In: Hamilton, S.R., Aaltonen, L.A., eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System. Lyon: IARC Press, 173–180.Google Scholar
- Okuda, K. 2001. Okuda, K., Mitchell, D.G., Itai, Y., Ariyama, J., eds. Hepatobiliary Diseases. Oxford: Blackwell Science.Google Scholar
- Portman, B.C., and Nakanuma, Y. 2006. Diseases of bile ducts. Burt, A.D., Portman, B.C. Ferrell, L.D., eds. MacSween's Pathology of the Liver. Churchill Livingstone 5th ed., pp. 517–581.Google Scholar
- Terada, T., Nakanuma, Y., Kono, N., Ueda, K., Kadoya, M., and Matsui, O. 1990. Ciliated hepatic foregut cyst. A mucus histochemical, immunohistochemical, and ultrastructural study in three cases in comparison with normal bronchi and intrahepatic bile ducts. Am. J. Surg. Pathol. 14: 356–363.PubMedCrossRefGoogle Scholar
- Zamboni, G., Longnecker, D.S., Kloppel, G., Adler, G., and Hruban, R.H. 2000. Mucinous cystic neoplasm of the pancreas. In: Hamilton SR, Aaltonen LA, eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System. Lyon: IARC Press, pp. 234–236.Google Scholar
- Zen, Y., Fujii, T., Itatsu, K., Nakamura, K., Konishi, F., Masuda, S., Mitsui, T., Asada, Y., Miura, S., Miyayama, S., Uehara, T., Katsuyama, T., Ohta, T., Minato, H., and Nakanuma, Y. 2006a. Biliary cystic tumors with bile duct communication: a cystic variant of intraductal papillary neoplasm of the bile duct. Mod. Pathol. 19: 1243–1254.CrossRefGoogle Scholar
- Zen, Y., Fujii, T., Itatsu, K., Nakamura, K., Minato, H., Kasashima, S., Kurumaya, H., Katayanagi, K., Kawashima, A., Masuda, S., Niwa, H., Mitsui, T., Asada, Y., Miura, S., Ohta, T., and Nakanuma, Y. 2006b. Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas. Hepatology 44: 1333–1343.CrossRefGoogle Scholar
- Zen, Y., Sasaki, M., Fujii, T., Chen, T.C., Chen, M.F., Yeh, T.S., Jan, Y.Y., Huang, S.F., Nimura, Y., and Nakanuma, Y. 2006d. Different expression patterns of mucin core proteins and cytokeratins during intrahepatic cholangiocar-cinogenesis from biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile duct — an immunohistochemical study of 110 cases of hepatolithiasis. J. Hepatol. 44: 350–358.CrossRefGoogle Scholar