Learning objectives
To illustrate intraductal papillary neoplasms of the pancreas,
bile duct,
gallbladder,
and ampulla by contrasting the CT/MRI images with histological findings
To provide a comprehensive understanding of these neoplasms and to summarize their characteristics.
Background
In the WHO 2010 classification of tumors,
macroscopically recognizable papillary neoplastic lesions in the biliary system,
as counterparts of pancreatic intraductal papillary mucinous neoplasms (IPMN),
were described: lesions in the bile duct were defined as intraductal papillary neoplasm of bile duct (IPNB) and those in the gallbladder as intracholecystic papillary tubular neoplasm (ICPN).
Papillary neoplastic lesions in the papilla of Vater,
proliferating in the papillary duct (common channel–intrapapillary bile duct/pancreatic duct) and differentiating from the surrounding mucosa,
have also been proposed and are collectively referred...
Findings and procedure details
Anatomy and Embryology
The pancreas and biliary tract are anatomically and embryologically related to each other.
These organs are anatomically adjacent to each other and,
embryologically,
both arise from the foregut endoderm almost at the same time.
The ventral pancreas develops from the biliary primordium and fuses with the dorsal pancreas to form the pancreas.
Moreover,
the pancreas and biliary tract share the same transcription factors during their development process.
Among these transcription factors,
reduced HES1 expression is considered to inhibit the development of the...
Conclusion
Intraductal papillary neoplasms in the pancreaticobiliary system typically develop from precancerous lesions or noninvasive cancerous lesions,
and their development is characterized by the adenoma-carcinoma sequence.
The prognosis is better than that of conventional invasive adenocarcinomas.
Imaging studies showed that all cases had an elevated papillary lesion in the pancreaticobiliary area with limited invasion into the surrounding area.
Dilatation of the pancreatic or biliary duct associated with mucus production was observed.
Understanding of the imaging and histological characteristics of these diseases is considered to facilitate imaging...
Personal information
J.
Munechika
Showa University School of Medicine,
Department of Radiology,
Tokyo,
Japan
Mail:
[email protected]
References
Albores-Saavedra J,
Adsay NV,
Crawford JM,
et al.
Carcinoma of the gallbladder and extrahepatic bile ducts.
In: Bosman FT,
Carneiro F,
Hruban R,
et al,
eds.
World Health Organization classification of Tumors of the Digestive System.
4th ed.
Lyon: IARC press;2010.p266-274.
Katabathina VS,
Flaherty EM,
Dasyam AK,
et al.
Biliary diseases with pancreatic counterparts: Cross-sectional imaging findings.
Radiographics 2016;36:374-392.
Tanaka M,
Castillo CF,
Adsay V,
et al.
International consensus guidelines 2012 for the management of ICPN and MCN of the pancreas.
Pancreatology 2012;12:183-197.
Yamada Y,...