John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Intraductal papillary neoplasm of the bile duct: A biliary equivalent to intraductal papillary mucinous neoplasm of the pancreas? Volume 21, issue 6, Juin 2014

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Authors
Hôpital Beaujon,
pôle des maladies de l’appareil digestif,
service de gastroentérologie et pancréatologie,
100, boulevard du général Leclerc
92118 Clichy Cedex, France ;
Université Paris-Diderot-Paris 7,
DHU Unity,
France
* Tirés à part

Intraductal papillary biliary neoplasm of the bile duct (IPN-B) is a rare intraductal tumor characterized by a papillary proliferation of the biliary epithelium responsible of a variable mucin hypersecretion, causing a dilatation of the bile ducts. IPN-B is the biliary equivalent to intraductal papillary mucinous neoplasm of the pancreas (IPMN). Like IPMN, there are 4 histological types with different prognosis. Magnetic resonance cholangiopancreatography (MRCP) and abdominal ultrasonography are the key procedure for diagnosis showing cystic lesion of the biliary tree associated with down-stream ductal dilatation. The distribution of histological types is different with a predominance of gastric subtypes in IPMN and pancreatobiliary subtypes in IPN-B explaining a better prognosis of IPMN. Carcinogenesis of IPN -B is characterised by an evolution from adenoma to adenocarcinoma. Seventy four per cent of IPN-B are diagnosed at the stage of in situ carcinoma or cholangiocarcinoma. Without contraindication, surgery is the best treatment because of the high risk of malignancy. The 5-year postoperative survival rate is 44 % for the invasive carcinoma.