Biliary Intraductal Papillary Neoplasm

Abstract

The intraductal papillary neoplasm of the bile duct (IPNB) is a rare, little-known entity, regarded as the biliary equivalent of intraductal papillary mucinous neoplasm of the pancreas (IPMN-P). It is considered a premalignant lesion, which progresses in a multistep fashion towards invasive cholangiocarcinoma. IPNB can occur in any segment of the bile duct, presenting multiple foci and a variety of symptoms including abdominal pain, dyspepsia, jaundice, repetition cholangitis and weight loss. Between 5% and 29% of patients are asymptomatic. The most common radiological findings are dilatation of the bile duct and the presence of intraductal masses. Free margin resection is the treatment of choice for IPNB regardless of size, location, and initial benign status, since recurrent episodes of cholangitis and obstructive jaundice caused by mucin production may cause serious clinical problems. In patients who are not candidates for surgery, treatment is mainly limited to the creation of a biliary bypass to relieve jaundice and/or cholangitis.