Browsing by Subject "Papillary neoplasm"

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    CK20 and lymph node involvement predict adverse outcome of malignant intraductal papillary neoplasm of the bile duct
    (Universidad de Murcia, Departamento de Biologia Celular e Histiologia, 2020) Shi, Jie; Wan, Xueshuai; Xie, Yuan; Lin, Jianzhen; Long, Junyu; Xu, Weiyu; Liang, Zhiyong; Sang, Xinting; Zhao, Haitao
    Objectives. To identify prognostic factors of malignant intraductal papillary neoplasm of the bile duct (m-IPNB). Materials and Methods. We included 38 consecutive cases which underwent surgical resection and diagnosed as IPNB with malignant component from January 2003 to January 2017. Clinicopathological variables were collected to conduct survival analysis and identify prognostic factors. Results. The median overall survival (OS) of m- IPNB was 76.0 months, with 1-, 3-, and 5-year survival rates of 97.2%, 73.5%, and 59.8%, respectively. The median recurrence-free survival (RFS) was 48.0 months with 1-, 3-, and 5-year RFS rate was 83.2%, 59.8%, and 44.6%, respectively. Univariate analysis showed that elevation of carcinoembrionic antigen (CEA), lymph node involvement, resection margin status, degree of periductal invasion, and positive expression of CK20 were associated with both OS and RFS of m-IPNB. After multivariate Cox models analysis, lymph node involvement and positive expression of CK20 were identified as independent prognostic factors for OS, while lymph node involvement and resection margin status were independent prognostic factors for RFS. The median OS of patients with m-IPNB involving lymphatic metastases and positive expression of CK20 was 27.0±8.8 months and 51.0±12.4 months, respectively. The median RFS of cases with lymph node involvement and R1 resection was 10.0±3.3 months and 25.0±6.9 months, respectively. However, there was no significant difference in OS or RFS between cases of pancreaticobiliary and intestinal subtype. Conclusions. Lymph node involvement and positive expression of CK20 are independent prognostic factors for shorter OS of m-IPNB, while patients with lymph node involvement and positive resection margin are at higher risk of tumor recurrence.
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    Intraductal neoplasms of the bile duct. A new challenge to biliary tract tumor pathology
    (Universidad de Murcia. Departamento de Biología Celular e Histología, 2017) Nakanuma, Yasuni; Uesaka, Katsuhiko; Miyayama, Shiro; Yamaguchi, Hiroshi; Ohtsuka, Masayuki
    Invasive biliary tract carcinomas are usually tubular adenocaricnomas with abundant desmoplastic reactions and frequent ductal and periductal invasion at the time of the diagnosis. Recently, several intraductal neoplasms of the bile duct, particularly at a pre-invasive stage, have been recognized. They include intraductal papillary neoplasm of the bile duct (IPNB), biliary intraepithelial neoplasm (BilIN), and others, such as intraductal tubulopapillary neoplasm (ITPN) of the bile duct. IPNBs are grossly visible predominantly intraductal-growing papillary neoplasms covered by well-differentiated neoplastic epithelium with fine fibrovascular cores in the dilated bile ducts. Regarding their similarities to intraductal papillary mucinous neoplasm of the pancreas (IPMN) of main pancreatic duct type, some IPNBs resemble IPMN (“pancreatic type”), while others are only somewhat similar or variably different from IPMN (“non-pancreatic type”). Some IPNBs develop via a common oncogenic signaling pathway, and others, particularly those of intestinal type, frequently show GNAS mutations, as in IPMN. BilINs are a microscopically recognizable flat or micropapillary pre-invasive neoplasm and are presumed to precede conventional nodular-sclerosing cholangiocarcinomas. ITPN of the bile duct is a rare neoplasm composed of densely packed tubular glands. These three types of neoplasms are not infrequently associated with invasive adenocarcinoma. Pre-invasive intraglandular neoplasms of the peribiliary glands, another epithelial system in the biliary tree, have been also reported. Further characterization of these intraductal and intraglandular neoplasms of the bile duct is needed to overcome devastating invasive biliary tract carcinoma.