Letters To The Editor
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World J Gastroenterol. Sep 28, 2013; 19(36): 6125-6126
Published online Sep 28, 2013. doi: 10.3748/wjg.v19.i36.6125
Metachronous intracystic and intraductal papillary neoplasms of the biliary tree
Hirohide Sato, Yasunori Sato, Kenichi Harada, Motoko Sasaki, Katsuyasu Hirano, Yasuni Nakanuma
Hirohide Sato, Yasunori Sato, Kenichi Harada, Motoko Sasaki, Yasuni Nakanuma, Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan
Katsuyasu Hirano, Department of Surgery, Wajima Hospital, Wajima, Ishikawa 928-8585, Japan
Author contributions: Sato H, Harada K, and Sasaki M contributed to pathological diagnosis of this case; Sato Y contributed to preparation of the manuscript; Hirano K attended to the patient; Nakanuma Y wrote the manuscript.
Correspondence to: Yasuni Nakanuma, MD, Professor, Department of Human Pathology, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa 920-8640, Japan. nakanuma@staff.kanazawa-u.ac.jp
Telephone: +81-76-2652197 Fax: +81-76-2344229
Received: January 9, 2013
Revised: April 26, 2013
Accepted: May 17, 2013
Published online: September 28, 2013
Processing time: 260 Days and 8.1 Hours
Abstract

A 77-year-old woman complained of epigastralgia, and a tumor (5 cm in diameter) of the gallbladder neck was detected by image analysis. Following cholecystectomy, the tumor was pathologically diagnosed as intraductal papillary neoplasm (IPN), gastric type, with associated invasive carcinoma. About 10 mo later, intraluminal multiple masses (3 foci, up to 1.8 cm) were noted in the extrahepatic bile duct, and the resected specimen showed that all tumors had similar gross and microscopic features as seen in gallbladder IPN without invasion, and they were synchronous multiple lesions. This case showed a papillary tumor of the gallbladder of gastric phenotype, and confirmed that the gallbladder is a target of IPN in addition to the bile ducts.

Keywords: Intraductal papillary neoplasm; Intracystic papillary neoplasm; Gastric type; Metachronous occurrence; Synchronous occurrence

Core tip: Recently, the papillary or tumoral neoplastic lesions within the lumen of the biliary tree including the gallbladder, papilla of Vater, and pancreatic duct have been proposed collectively as a preinvasive neoplastic lesion. The patient reported here was an interesting case of intraluminal papillary neoplasm involving the gallbladder and metachronously the extrahepatic bile duct. This letter to the editor encourages clinicians to detect more of such neoplastic lesions.