THE ROLE OF CHOLANGIOSCOPY IN THE DIAGNOSIS OF INTRADUCTAL PAPILLARY NEOPLASM OF THE BILE DUCT

Aims Intraductal papillary neoplasms of the bile duct (IPNB) constitute 10 to 15% of all bile duct tumors. They are characterized by a papillary or villous neoplasm with a histological spectrum raging from benign disease to invasive malignancy. IPNB can present surreptitiously as an intraductal mass within a dilated intrahepatic or extrahepatic bile duct. We intend to bring attention as its rarity in Western countries and tendency to masquerade as biliary stone disease can prevent its early diagnosis and management.

Methods An asymptomatic 77-year-old man with dilation of the biliary tree was referred to our Gastroenterology department.

Results He had no previous surgeries and liver enzymes were normal. Magnetic resonance cholangiopancreatography was performed, confirming a dilation of the intrahepatic bile ducts, more prominently of the left hepatic duct (16 mm), and common bile duct (CBD; 15 mm). The patient had been previously submitted to an endoscopic retrograde cholangiopancreatography (ERCP) that didn’t reveal any obstructive lesions. Endoscopic ultrasonography showed a dilated common bile duct (14 mm) with some echogenic material inside without acoustic shadowing and a diffuse thickening of the bile duct wall. Since IgG4 was normal and a subsequent CT scan revealed a mass-forming structure in the left biliary duct, the patient was proposed to ERCP with cholangioscopy. It showed a thick mucoid secretion and multiple lesions with “fish-egg”/papillomatous appearance protruding in the dilated CBD. Biopsies confirmed the suspected diagnosis of intraductal papillary neoplasm of the bile duct with low grade dysplasia. The patients refused surgical intervention and remains asymptomatic.

Fig. 1

Publication History

Article published online:
14 April 2022