title: Cystic micropapillary neoplasm of peribiliary glands with concomitant perihilar cholangiocarcinoma.
abstract: We report a case of a 75-year-old man with cystic micropapillary neoplasm of peribiliary glands detected preoperatively by radiologic examination. Enhanced computed tomography showed a low-density mass 2.2 cm in diameter in the right hepatic hilum and a cystic lesion around the common hepatic duct. Under a diagnosis of perihilar cholangiocarcinoma, right hepatectomy with caudate lobectomy and bile duct resection were performed. Pathological examination revealed perihilar cholangiocarcinoma mainly involving the right hepatic duct. The cystic lesion was multilocular and covered by columnar lining epithelia exhibiting increased proliferative activity and p53 nuclear expression; it also contained foci of micropapillary and glandular proliferation. Therefore, the lesion was diagnosed as a cystic micropapillary neoplasm of peribiliary glands and resembled flat branch-type intraductal papillary mucinous neoplasm of the pancreas. Histological examination showed the lesion was discontinuous with the perihilar cholangiocarcinoma. Immunohistochemistry showed the cystic neoplasm was strongly positive for MUC6 and that the cholangiocarcinoma was strongly positive for MUC5AC and S100P. These results suggest these two lesions have different origins. This case warrants further study on whether this type of neoplasm is associated with concomitant cholangiocarcinoma as observed in pancreatic intraductal papillary mucinous neoplasm with concomitant pancreatic duct adenocarcinoma.
authors.affiliation: Tsuneyuki Uchida, Yusuke Yamamoto, Takaaki Ito, Yukiyasu Okamura, Teiichi Sugiura, Katsuhiko Uesaka, Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka 4118777, Japan.
authors.forename: Tsuneyuki
authors.initials: T
authors.lastname: Uchida
authors.affiliation: Tsuneyuki Uchida, Yusuke Yamamoto, Takaaki Ito, Yukiyasu Okamura, Teiichi Sugiura, Katsuhiko Uesaka, Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka 4118777, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Tsuneyuki Uchida, Yusuke Yamamoto, Takaaki Ito, Yukiyasu Okamura, Teiichi Sugiura, Katsuhiko Uesaka, Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka 4118777, Japan.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Ito
authors.affiliation: Tsuneyuki Uchida, Yusuke Yamamoto, Takaaki Ito, Yukiyasu Okamura, Teiichi Sugiura, Katsuhiko Uesaka, Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka 4118777, Japan.
authors.forename: Yukiyasu
authors.initials: Y
authors.lastname: Okamura
authors.affiliation: Tsuneyuki Uchida, Yusuke Yamamoto, Takaaki Ito, Yukiyasu Okamura, Teiichi Sugiura, Katsuhiko Uesaka, Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka 4118777, Japan.
authors.forename: Teiichi
authors.initials: T
authors.lastname: Sugiura
authors.affiliation: Tsuneyuki Uchida, Yusuke Yamamoto, Takaaki Ito, Yukiyasu Okamura, Teiichi Sugiura, Katsuhiko Uesaka, Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka 4118777, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Uesaka
authors.affiliation: Tsuneyuki Uchida, Yusuke Yamamoto, Takaaki Ito, Yukiyasu Okamura, Teiichi Sugiura, Katsuhiko Uesaka, Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, Sunto-gun, Shizuoka 4118777, Japan.
authors.forename: Yasuni
authors.initials: Y
authors.lastname: Nakanuma
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000368:Aged; D001650:Bile Duct Neoplasms / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001662:Biliary Tract Surgical Procedures; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D006498:Hepatectomy; D006500:Hepatic Duct, Common / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D018285:Klatskin Tumor / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008297:Male; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D009378:Neoplasms, Multiple Primary; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Gastric type; Intraductal papillary neoplasm of the bile duct; Peribiliary gland; Perihilar cholangiocarcinoma