Extrahepatic bile ducts
Tumors
Intraductal papillary neoplasms of biliary tract

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 8 February 2018, last major update September 2012

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PubMed Search: Intraductal papillary neoplasms of biliary tract[TIAB]

Cite this page: Gulwani, H. Intraductal papillary neoplasms of biliary tract. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/gallbladderIPMN.html. Accessed February 21st, 2018.
Definition / general
  • Uncommon
  • Solitary or may spread along biliary tree to cystic duct or duodenal papilla
  • May resemble intrapapillary mucinous neoplasms of pancreas as both arise within a dilated duct system and demonstrate predominantly intraductal growth
  • Risk factor for cholangiocarcinoma, biliary obstruction, recurring ascending cholangitis
  • Are often carcinomas (HPB (Oxford) 2009;11:684)
  • p21, p53, cyclin D1, DPC4 are involved in neoplastic progression (Hum Pathol 2008;39:1153)
Case reports
Gross description
  • Either polypoid, cast-like growth, superficial spreading or cystic type but does not correlate with prognosis (Abdom Imaging 2011;36:438)
Microscopic (histologic) description
  • Papillary fronds with fine vascular cores
  • Epithelial cells are either biliary type or have gastric or intestinal differentiation with goblet cells and Paneth cells
  • Production of extracellular intraductal mucin less common than papillary IPMN
  • Variants have oncocytic changes or cysts (Mod Pathol 2006;19:1243)
  • Borderline tumor: mild to moderate nuclear atypia and nuclear pseudostratification limited to basal 2/3 of the epithelium
  • Carcinoma: severe cytological atypia, loss of nuclear polarity or architectural cribriforming / papillary fusion is present
Microscopic (histologic) images

Images hosted on other servers:
Positive stains
Negative stains
Molecular / cytogenetics description
  • KRAS activating mutations (29%), 18q- (31%) but no loss of DPC4
  • Often has microsatellite instability (Mod Pathol 2002;15:1309)