Intraductal tubulopapillary neoplasm of the bile ducts
Intraductal tubulopapillary neoplasms of the bile ducts are rare intraluminal mass forming pre-invasive biliary neoplasms with no mucin production.
ITPNs of the bile ducts are rare tumors of unknown incidence, found more frequently in women at their 60s 1,2.
These tumors are postulated as the counterpart of the pancreatic intraductal tubulopapillary neoplasms 2.
On gross specimen, the lesions are seen as single or multiple intraductal tan granular nodules within a dilated bile duct. When an invasive component is present, it is shown as an infiltrative white scirrhous area within the liver parenchyma, of firm consistency 2.
The intraductal polypoid masses are usually covered by the bile duct epithelium and show a characteristic tubular pattern of intraductal tubulopapillary neoplasm with solid tubular areas 2.
They typically express the mucin glycoproteins MUC1 and MUC6 and do not express the MUC2 and MUC5AC 1.
On imaging, ITPNs of the bile ducts present as intraductal soft tissue masses that are usually larger than the ones seen in intraductal papillary neoplasms of the bile duct (IPNB), and are not associated with downstream biliary tree dilatation given its lack in mucin production 1. The mass is usually associated with upstream biliary tree dilatation and focal liver atrophy/hepatic capsule retraction.
Postcontrast CT images show tumor enhancement and patchy enhancement within the liver parenchyma surrounding the dilated ducts 1.
Treatment and prognosis
Metastatic disease has been described involving the lungs, duodenum, peritoneum, and retroperitoneum 1.
Although the studies series on this condition are still scarce, ITPNs are believed to have a worse prognosis compared to IPNBs but better compared to cholangiocarcinoma 1.
- 1. Argha Chatterjee, Camila Lopes Vendrami, Paul Nikolaidis, Pardeep K. Mittal, Andrew J. Bandy, Christine O. Menias, Nancy A. Hammond, Vahid Yaghmai, Guang-Yu Yang, Frank H. Miller. Uncommon Intraluminal Tumors of the Gallbladder and Biliary Tract: Spectrum of Imaging Appearances. (2019) RadioGraphics. 39 (2): 388-412. doi:10.1148/rg.2019180164 - Pubmed
- 2. Anna Melissa Schlitter, Kee-Taek Jang, Günter Klöppel, Burcu Saka, Seung-Mo Hong, Hyejeong Choi, George Johan Offerhaus, Ralph H Hruban, Yoh Zen, Björn Konukiewitz, Ivonne Regel, Michael Allgäuer, Serdar Balci, Olca Basturk, Michelle D Reid, Irene Esposito, Volkan Adsay. Intraductal tubulopapillary neoplasms of the bile ducts: clinicopathologic, immunohistochemical, and molecular analysis of 20 cases. (2015) Modern Pathology. 28 (9): 1249. doi:10.1038/modpathol.2015.61 - Pubmed
- 3. Hyo Jung Park, So Yeon Kim, Hyoung Jung Kim, Seung Soo Lee, Gil Sun Hong, Jae Ho Byun, Seung-Mo Hong, Moon-Gyu Lee. Intraductal Papillary Neoplasm of the Bile Duct: Clinical, Imaging, and Pathologic Features. (2018) American Journal of Roentgenology. 211 (1): 67-75. doi:10.2214/AJR.17.19261 - Pubmed
Related Radiopaedia articles
Gallbladder and biliary tract pathology
- congenital malformations and anatomical variants
- gallbladder inflammation
- bile ducts inflammation
- gallbladder wall abnormalities
- diffuse gallbladder wall thickening (differential)
- focal gallbladder wall thickening (differential)
- porcelain gallbladder
- gallbladder polyps
- gallbladder malignancy
- other gallbladder abnormalities
- bile ducts neoplasms