title: An intraductal papillary neoplasm of the bile duct mimicking a hemorrhagic hepatic cyst: a case report.
abstract: An intraductal papillary neoplasm of the bile duct is a biliary, epithelium-lined, cystic lesion that exhibits papillary proliferation and rarely causes large hemorrhagic cystic lesions. Here, we report a case of an intraductal papillary neoplasm of the bile duct mimicking a hemorrhagic hepatic cyst in a middle-aged man with large hemorrhagic hepatic cysts who experienced abdominal pain and repeated episodes of intracystic bleeding. Following portal vein embolization, extended right hepatic lobectomy was performed, and intraoperative cholangiography revealed communication between the intracystic space and the hepatic duct. Although histological studies revealed that the large hemorrhagic lesion was not lined with epithelium, the surrounding multilocular lesions contained biliary-derived epithelial cells that presented as papillary growths without ovarian-like stroma. A diagnosis of oncocytic-type intraductal papillary neoplasm of the bile duct was made, and we hypothesized that intracystic bleeding with denudation of the lining epithelial cells might occur as the cystically dilated bile duct increased in size. Differential diagnosis between a hemorrhagic cyst and a cyst-forming intraductal papillary neoplasm of the bile duct with bleeding is difficult. However, an intraductal papillary neoplasm of the bile duct could manifest as multilocular hemorrhagic lesions; therefore, complete resection should be performed for a better prognosis.
authors.affiliation: Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan. kakisaka@k2.dion.ne.jp
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kakisaka
authors.forename: Toshiya
authors.initials: T
authors.lastname: Kamiyama
authors.forename: Hideki
authors.initials: H
authors.lastname: Yokoo
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Nakanishi
authors.forename: Kenji
authors.initials: K
authors.lastname: Wakayama
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Tsuruga
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kamachi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Mitsuhashi
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D001662:Biliary Tract Surgical Procedures; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000601:surgery; D003560:Cysts / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D006470:Hemorrhage / Q000175:diagnosis* / Q000601:surgery; D006500:Hepatic Duct, Common / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D011379:Prognosis; D014057:Tomography, X-Ray Computed