title: Intraductal papillary neoplasm of the bile duct in liver cirrhosis with hepatocellular carcinoma.
abstract: A case of intraductal papillary neoplasm of the bile duct (IPNB) arising in a patient with hepatitis B-related liver cirrhosis with hepatocellular carcinoma (HCC) is reported. A 76-year-old man was admitted to our hospital with recurrent HCC. Laboratory data showed that levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated. He died of progressive hepatic failure. At autopsy, in addition to HCCs, an intraductal papillary proliferation of malignant cholangiocytes with fibrovascular cores was found in the dilated large bile ducts in the left lobe, and this papillary carcinoma was associated with an invasive mucinous carcinoma (invasive IPNB). Interestingly, extensive intraductal spread of the cholangiocarcinoma was found from the reactive bile ductular level to the interlobular bile ducts and septal bile ducts and to the large bile ducts in the left lobe. Neural cell adhesion molecule, a hepatic progenitor cell marker, was detected in IPNB cells. It seems possible in this case that hepatic progenitor cells located in reactive bile ductules in liver cirrhosis may have been responsible for the development of the cholangiocarcinoma and HCC, and that the former could have spread in the intrahepatic bile ducts and eventually formed grossly visible IPNB.
authors.affiliation: Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa 920-8640, Japan.
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sato
authors.forename: Kenichi
authors.initials: K
authors.lastname: Harada
authors.forename: Norihide
authors.initials: N
authors.lastname: Yoneda
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Ueda
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawashima
authors.lastname: Akishiooi
authors.forename: Yasunin
authors.initials: Y
authors.lastname: Nakanuma
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology*; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000473:pathology*; D017809:Fatal Outcome; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology*; D008297:Male