Limits...
Radiological spectrum of intraductal papillary tumors of the bile ducts.

Lim JH, Yi CA, Lim HK, Lee WJ, Lee SJ, Kim SH - Korean J Radiol (2002 Jan-Mar)

Bottom Line: Radiologically, the biliary tree is diffusely dilated, either in a lobar or segmental fashion, or aneurysmally, depending on the location of the tumor, the debris, and the amount of mucin production.A tumor can be depicted by imaging as an intraductal mass with a thickened and irregular bile duct wall.Cystically or aneurysmally, dilated bile ducts in mucin-hypersecreting variants (intraductal papillary mucinous tumors) should be differentiated from cystadenoma, cystadenocarcinoma and liver abscess.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea. jhlim@smc.samsung.co.kr

ABSTRACT
Papillary tumor of the bile duct is characterized by the presence of an intraductal tumor with a papillary surface comprising innumerable frondlike infoldings of proliferated columnar epithelial cells surrounding slender fibrovascular stalks. There may be multiple tumors along the bile ducts (papillomatosis or papillary carcinomatosis), which are dilated due to obstruction by a tumor per se, by sloughed tumor debris, or by excessive mucin. Radiologically, the biliary tree is diffusely dilated, either in a lobar or segmental fashion, or aneurysmally, depending on the location of the tumor, the debris, and the amount of mucin production. A tumor can be depicted by imaging as an intraductal mass with a thickened and irregular bile duct wall. Sloughed tumor debris and mucin plugs should be differentiated from bile duct stones. Cystically or aneurysmally, dilated bile ducts in mucin-hypersecreting variants (intraductal papillary mucinous tumors) should be differentiated from cystadenoma, cystadenocarcinoma and liver abscess.

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A 63-year-old man with papillary adenomatosis in the common hepatic duct.A. Sonogram reveals dilated extrahepatic bile ducts and an echogenic cast filling the common hepatic duct (curved arrows). Note the presence of a slit-like defect in the cast (arrow).B. Post-contrast CT image shows the thickened wall of the extrahepatic bile duct (open arrow). Note that in the center of the duct, a slit-like lumen is present.C. Endoscopic retrograde cholangiogram depicts a papillary tumor in the common hepatic duct (arrows) and severe dilatation of the intra- and extrahepatic bile ducts. Note the velvety appearance, serrated margin, and nodular filling defects of the involved segment.
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Figure 4: A 63-year-old man with papillary adenomatosis in the common hepatic duct.A. Sonogram reveals dilated extrahepatic bile ducts and an echogenic cast filling the common hepatic duct (curved arrows). Note the presence of a slit-like defect in the cast (arrow).B. Post-contrast CT image shows the thickened wall of the extrahepatic bile duct (open arrow). Note that in the center of the duct, a slit-like lumen is present.C. Endoscopic retrograde cholangiogram depicts a papillary tumor in the common hepatic duct (arrows) and severe dilatation of the intra- and extrahepatic bile ducts. Note the velvety appearance, serrated margin, and nodular filling defects of the involved segment.

Mentions: At sonography, CT or MR cholangiography, the bile ducts of the involved hepatic segment, hepatic lobe or entire biliary tree are seen to be dilated. When the tumor involves a segment or one hepatic lobe, the degree of bile duct dilatation is thus particularly severe, and the dilated bile duct appears crowded (Fig. 3). At ultrasonography, an introductal mass is usually echogenic (Figs. 3-5). As it is confined within the bile ducts, the echogenic walls remain intact (2). At CT, an intraductal papillary tumor can appear as a hypo- or isoattenuating soft tissue mass within the dilated duct relative to the hepatic parenchyma, or as segmental thickening of the wall of the bile ducts (3, 4) (Figs. 3 and 4). At contrast enhanced CT, attenuation may be increased, and the outer margin of the thickened bile duct wall is smooth and clear. When it is small and isoattenuating to adjacent hepatic parenchyma, or when complex orientation of the dilated bile ducts obscures the presence of a mass, a tumor is not always depicted (3, 4). At endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography, the biliary tree is diffusely dilated, and biliary obstruction is usually partial. A tumor may be small and flat, and the ductal wall is sometimes irregular (2-4). A mass reveals fine surface irregularities, either in the form of a velvety or serrated contour, representing the tumor's papillary surface (Figs. 4 and 5). The gallbladder and cystic duct may also be involved (Fig. 5). It is impossible to differentiate benign from malignant papillary tumors solely on the basis of the radiological findings.


Radiological spectrum of intraductal papillary tumors of the bile ducts.

Lim JH, Yi CA, Lim HK, Lee WJ, Lee SJ, Kim SH - Korean J Radiol (2002 Jan-Mar)

A 63-year-old man with papillary adenomatosis in the common hepatic duct.A. Sonogram reveals dilated extrahepatic bile ducts and an echogenic cast filling the common hepatic duct (curved arrows). Note the presence of a slit-like defect in the cast (arrow).B. Post-contrast CT image shows the thickened wall of the extrahepatic bile duct (open arrow). Note that in the center of the duct, a slit-like lumen is present.C. Endoscopic retrograde cholangiogram depicts a papillary tumor in the common hepatic duct (arrows) and severe dilatation of the intra- and extrahepatic bile ducts. Note the velvety appearance, serrated margin, and nodular filling defects of the involved segment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713988&req=5

Figure 4: A 63-year-old man with papillary adenomatosis in the common hepatic duct.A. Sonogram reveals dilated extrahepatic bile ducts and an echogenic cast filling the common hepatic duct (curved arrows). Note the presence of a slit-like defect in the cast (arrow).B. Post-contrast CT image shows the thickened wall of the extrahepatic bile duct (open arrow). Note that in the center of the duct, a slit-like lumen is present.C. Endoscopic retrograde cholangiogram depicts a papillary tumor in the common hepatic duct (arrows) and severe dilatation of the intra- and extrahepatic bile ducts. Note the velvety appearance, serrated margin, and nodular filling defects of the involved segment.
Mentions: At sonography, CT or MR cholangiography, the bile ducts of the involved hepatic segment, hepatic lobe or entire biliary tree are seen to be dilated. When the tumor involves a segment or one hepatic lobe, the degree of bile duct dilatation is thus particularly severe, and the dilated bile duct appears crowded (Fig. 3). At ultrasonography, an introductal mass is usually echogenic (Figs. 3-5). As it is confined within the bile ducts, the echogenic walls remain intact (2). At CT, an intraductal papillary tumor can appear as a hypo- or isoattenuating soft tissue mass within the dilated duct relative to the hepatic parenchyma, or as segmental thickening of the wall of the bile ducts (3, 4) (Figs. 3 and 4). At contrast enhanced CT, attenuation may be increased, and the outer margin of the thickened bile duct wall is smooth and clear. When it is small and isoattenuating to adjacent hepatic parenchyma, or when complex orientation of the dilated bile ducts obscures the presence of a mass, a tumor is not always depicted (3, 4). At endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography, the biliary tree is diffusely dilated, and biliary obstruction is usually partial. A tumor may be small and flat, and the ductal wall is sometimes irregular (2-4). A mass reveals fine surface irregularities, either in the form of a velvety or serrated contour, representing the tumor's papillary surface (Figs. 4 and 5). The gallbladder and cystic duct may also be involved (Fig. 5). It is impossible to differentiate benign from malignant papillary tumors solely on the basis of the radiological findings.

Bottom Line: Radiologically, the biliary tree is diffusely dilated, either in a lobar or segmental fashion, or aneurysmally, depending on the location of the tumor, the debris, and the amount of mucin production.A tumor can be depicted by imaging as an intraductal mass with a thickened and irregular bile duct wall.Cystically or aneurysmally, dilated bile ducts in mucin-hypersecreting variants (intraductal papillary mucinous tumors) should be differentiated from cystadenoma, cystadenocarcinoma and liver abscess.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea. jhlim@smc.samsung.co.kr

ABSTRACT
Papillary tumor of the bile duct is characterized by the presence of an intraductal tumor with a papillary surface comprising innumerable frondlike infoldings of proliferated columnar epithelial cells surrounding slender fibrovascular stalks. There may be multiple tumors along the bile ducts (papillomatosis or papillary carcinomatosis), which are dilated due to obstruction by a tumor per se, by sloughed tumor debris, or by excessive mucin. Radiologically, the biliary tree is diffusely dilated, either in a lobar or segmental fashion, or aneurysmally, depending on the location of the tumor, the debris, and the amount of mucin production. A tumor can be depicted by imaging as an intraductal mass with a thickened and irregular bile duct wall. Sloughed tumor debris and mucin plugs should be differentiated from bile duct stones. Cystically or aneurysmally, dilated bile ducts in mucin-hypersecreting variants (intraductal papillary mucinous tumors) should be differentiated from cystadenoma, cystadenocarcinoma and liver abscess.

Show MeSH
Related in: MedlinePlus