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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 54-year-old woman with a mucin-producing, intraductal mucosal-spreading, papillary adenocarcinoma causing cystic and tubular dilatation of the intrahepatic bile ducts, complicated by abscess and rupture. (illustrations referred to in reference 7, and have been used with the authors' permission.)A. Contrast-enhanced CT scan of the left lobe obtained during the equilibrium phase shows balloon-like dilatation of the left lobar and segmental bile ducts (asterisk), as well as severe dilatation of surrounding peripheral bile ducts (arrows).B. CT scan 9 cm caudal to A demonstrates cyst-like (asterisk) and tubular dilatation of the bile ducts of the caudate lobe. Note that in the right hepatic lobe, the bile duct is slightly dilated.C. Endoscopic retrograde cholangiogram indicates that the extrahepatic bile ducts contain thread-and-streak-like multiple linear filling defects, representing mucus. The left hepatic duct is completely obstructed, and the right, partially so. In the right hepatic lobe, the bile duct is again slightly dilated.D. Photomicrograph of a resected specimen depicts balloon-like dilatation of the bile ducts, which are covered with diffusely thickened fibrotic wall. The luminal surface of one duct is lined by short papillary infoldings (star) but on other surfaces, papillary infoldings are denuded (asterisks). The arrow points to tumor growth at Glisson's capsule, due to perforation of the cystic tumor (H & E staining, ×10).
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Figure 6: A 54-year-old woman with a mucin-producing, intraductal mucosal-spreading, papillary adenocarcinoma causing cystic and tubular dilatation of the intrahepatic bile ducts, complicated by abscess and rupture. (illustrations referred to in reference 7, and have been used with the authors' permission.)A. Contrast-enhanced CT scan of the left lobe obtained during the equilibrium phase shows balloon-like dilatation of the left lobar and segmental bile ducts (asterisk), as well as severe dilatation of surrounding peripheral bile ducts (arrows).B. CT scan 9 cm caudal to A demonstrates cyst-like (asterisk) and tubular dilatation of the bile ducts of the caudate lobe. Note that in the right hepatic lobe, the bile duct is slightly dilated.C. Endoscopic retrograde cholangiogram indicates that the extrahepatic bile ducts contain thread-and-streak-like multiple linear filling defects, representing mucus. The left hepatic duct is completely obstructed, and the right, partially so. In the right hepatic lobe, the bile duct is again slightly dilated.D. Photomicrograph of a resected specimen depicts balloon-like dilatation of the bile ducts, which are covered with diffusely thickened fibrotic wall. The luminal surface of one duct is lined by short papillary infoldings (star) but on other surfaces, papillary infoldings are denuded (asterisks). The arrow points to tumor growth at Glisson's capsule, due to perforation of the cystic tumor (H & E staining, ×10).

Mentions: Sonography, CT, and MR cholangiopancreatography demonstrate severe dilatation of the intra- and extrahepatic ducts (Fig. 6); both proximal and distal to a tumor are dilated because mucin may obstruct the papilla of Vater. At CT, a tumor may appear as a small, flat mass, isoattenuating to adjacent liver tissue, while mucus is not visible. At sonography, a mucus plug usually echofree but may appear as a masslike, echogenic focus. It is difficult but not impossible to differentiate between a papillary tumor and mucus plugs or stones. Endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography may demonstrate that the dilated bile ducts contain large or small, multiple, amorphous filling defects caused by mucus plugs (3, 5). The tumor may or may not be visible.


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 54-year-old woman with a mucin-producing, intraductal mucosal-spreading, papillary adenocarcinoma causing cystic and tubular dilatation of the intrahepatic bile ducts, complicated by abscess and rupture. (illustrations referred to in reference 7, and have been used with the authors' permission.)A. Contrast-enhanced CT scan of the left lobe obtained during the equilibrium phase shows balloon-like dilatation of the left lobar and segmental bile ducts (asterisk), as well as severe dilatation of surrounding peripheral bile ducts (arrows).B. CT scan 9 cm caudal to A demonstrates cyst-like (asterisk) and tubular dilatation of the bile ducts of the caudate lobe. Note that in the right hepatic lobe, the bile duct is slightly dilated.C. Endoscopic retrograde cholangiogram indicates that the extrahepatic bile ducts contain thread-and-streak-like multiple linear filling defects, representing mucus. The left hepatic duct is completely obstructed, and the right, partially so. In the right hepatic lobe, the bile duct is again slightly dilated.D. Photomicrograph of a resected specimen depicts balloon-like dilatation of the bile ducts, which are covered with diffusely thickened fibrotic wall. The luminal surface of one duct is lined by short papillary infoldings (star) but on other surfaces, papillary infoldings are denuded (asterisks). The arrow points to tumor growth at Glisson's capsule, due to perforation of the cystic tumor (H & E staining, ×10).
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Related In: Results  -  Collection

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Figure 6: A 54-year-old woman with a mucin-producing, intraductal mucosal-spreading, papillary adenocarcinoma causing cystic and tubular dilatation of the intrahepatic bile ducts, complicated by abscess and rupture. (illustrations referred to in reference 7, and have been used with the authors' permission.)A. Contrast-enhanced CT scan of the left lobe obtained during the equilibrium phase shows balloon-like dilatation of the left lobar and segmental bile ducts (asterisk), as well as severe dilatation of surrounding peripheral bile ducts (arrows).B. CT scan 9 cm caudal to A demonstrates cyst-like (asterisk) and tubular dilatation of the bile ducts of the caudate lobe. Note that in the right hepatic lobe, the bile duct is slightly dilated.C. Endoscopic retrograde cholangiogram indicates that the extrahepatic bile ducts contain thread-and-streak-like multiple linear filling defects, representing mucus. The left hepatic duct is completely obstructed, and the right, partially so. In the right hepatic lobe, the bile duct is again slightly dilated.D. Photomicrograph of a resected specimen depicts balloon-like dilatation of the bile ducts, which are covered with diffusely thickened fibrotic wall. The luminal surface of one duct is lined by short papillary infoldings (star) but on other surfaces, papillary infoldings are denuded (asterisks). The arrow points to tumor growth at Glisson's capsule, due to perforation of the cystic tumor (H & E staining, ×10).
Mentions: Sonography, CT, and MR cholangiopancreatography demonstrate severe dilatation of the intra- and extrahepatic ducts (Fig. 6); both proximal and distal to a tumor are dilated because mucin may obstruct the papilla of Vater. At CT, a tumor may appear as a small, flat mass, isoattenuating to adjacent liver tissue, while mucus is not visible. At sonography, a mucus plug usually echofree but may appear as a masslike, echogenic focus. It is difficult but not impossible to differentiate between a papillary tumor and mucus plugs or stones. Endoscopic retrograde cholangiopancreatography or percutaneous transhepatic cholangiography may demonstrate that the dilated bile ducts contain large or small, multiple, amorphous filling defects caused by mucus plugs (3, 5). The tumor may or may not be visible.

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