Background
The prevalent location and incidence of intraductal papillary neoplasm of the bile duct (IPNB) and invasive carcinoma associated with them have varied markedly among studies due to ...differences in diagnostic criteria and tumor location.
Methods
IPNBs were classified into two types: Type 1 IPNB, being histologically similar to intraductal papillary mucinous neoplasm of the pancreas, and Type 2 IPNB, having a more complex histological architecture with irregular papillary branching or foci of solid‐tubular components. Medical data were evaluated.
Results
Among 694 IPNB patients, 520 and 174 had Type 1 and Type 2, respectively. The levels of AST, ALT, ALP, T. Bil, and CEA were significantly higher in patients with Type 2 than in those with Type 1. Type 1 IPNB was more frequently located in the intrahepatic bile duct than Type 2, whereas Type 2 was more frequently located in the distal bile duct than Type 1 IPNB (P < 0.001). There were significant differences in 5‐year cumulative survival rates (75.2% vs 50.9%; P < 0.0001) and 5‐year cumulative disease‐free survival rates (64.1% vs 35.3%; P < 0.0001) between the two groups.
Conclusion
Type 1 and Type 2 IPNBs differ in their clinicopathological features and prognosis. This classification may help to further understand IPNB.
Highlight
In this Japan‐Korea collaborative study, intraductal papillary neoplasms of the bile duct were classified into two types: Type 1, which is histologically similar to intraductal papillary‐mucinous neoplasm of the pancreas, and Type 2, which has a more complex histological architecture. Kubota and colleagues report differences in clinicopathological features and prognosis.
Clinical distinction between nail matrix nevus (NMN) and subungual melanoma (SUM) can be challenging. More precise delineation of the clinicodermoscopic characteristics specific for NMNs is needed.
...We sought to analyze the clinicopathologic features of childhood and adult NMNs and to propose clinicodermoscopic features that can aid in differentiating NMNs from SUM.
We retrospectively reviewed clinical, dermoscopic, and histologic findings of patients (20 children and 8 adults) in whom NMN was diagnosed between 2012 and 2015.
Except for 2 cases of total melanonychia, the affected nails demonstrated longitudinal melanonychia sharply demarcated from the adjacent nail plate. Melanonychia was wider among children than among adults (P = .002). Nail dystrophy was more frequent in wider lesions (P = .028). Hutchinson's sign was observed in pediatric cases at the hyponychium and/or proximal nailfold cuticles. All hyponychial pigmentations demonstrated a longitudinal brush pigmentation pattern under dermoscopy.
This was a retrospective study of Asians in a single center.
Our study is the largest case series to date of biopsy-confirmed NMNs. It highlighted important clinicodermoscopic differences between pediatric and adult NMNs. We propose that in pediatric cases of longitudinal melanonychia presenting as a sharply demarcated pigment band of even width, the presence of Hutchinson's sign with longitudinal brush pigmentation may favor a diagnosis of NMN over SUM.
Background
Radical cholecystectomy is recommended for T2 gallbladder cancer. However, it is unclear whether hepatic resection is essential for peritoneal-side gallbladder cancer.
Methods
From January ...2000 to December 2011, we identified T2 gallbladder cancer patients who had undergone curative intent surgery. A peritoneal-side tumor was defined when the epicenter of the tumor was located within the free peritoneal-side gallbladder mucosa. Hepatic-side gallbladder cancer was defined when the epicenter of the tumor was located within the gallbladder bed or neck.
Results
A total of 157 patients with T2 gallbladder cancer were included; 33 peritoneal-side and 124 hepatic-side tumors. In total, 122 patients underwent hepatic resection, whereas the remaining 35 patients did not. After a median follow-up period of 40 (range 5–170) months, the survival of the peritoneal-side group was better than that of the hepatic-side group (
p
= 0.002). In a multivariate analysis, tumor location, lymph node metastasis, hepatic resection, lymphatic invasion, and perineural invasion were significant prognostic factors (
p
= 0.045,
p
< 0.001,
p
= 0.003,
p
= 0.046, and
p
= 0.027, respectively). For the peritoneal-side group, there was no recurrence or death after cholecystectomy without hepatic resection. However, hepatic resection was an important factor associated with overall survival in patients with hepatic-side gallbladder cancer (
p
= 0.007).
Conclusions
In T2 gallbladder cancer patients, hepatic resection is recommended when there is tumor invasion of the gallbladder bed or neck. However, it is not always necessary in selected patients with peritoneal-side gallbladder cancer.
Aims
To improve the characterization of intraductal papillary neoplasm of the bile duct (IPNB) and mucinous cystic neoplasm of the liver (MCN‐L).
Methods and results
A retrospective review of ...pathology archives (1999–2011) in our three institutions identified cases of IPNB (n = 138) and MCN‐L (n = 54). The IPNB/MCN‐L ratio was 5.7:1 at Samsung Medical Centre in Seoul, which was significantly higher than those at the University of Washington Medical Center in Seattle (1:3.0) and King's College Hospital in London (1:6.3). This difference was mainly attributable to the considerably larger number of patients with IPNB in Seoul (n = 131) than in Seattle and London (n = 7). Western patients with IPNB were all non‐Asian in ancestry. IPNB differed from pancreatic intraductal papillary neoplasm in its higher histological grade, more advanced stage of an associated invasive cancer, and worse prognosis. In contrast, MCN‐L showed significantly lower histological grade than its pancreatic counterpart (P = 0.022). Unlike in pancreatic mucinous cystic neoplasm, malignant transformation was very rare in MCN‐L (10% versus 2%).
Conclusions
This study demonstrated demographic differences in IPNB and MCN‐L among regions. IPNB and MCN‐L differ from their pancreatic counterparts in the risk of malignant transformation and patients' prognosis.
Background
No studies have yet analyzed the characteristics of recurrence after resection for intraductal papillary neoplasm of bile duct (IPNB) based on tumor location. We analyzed the patterns, ...timing, and risk factors for recurrence.
Methods
From 1994 to 2014, data from 103 patients who were diagnosed with IPNB were retrospectively reviewed. Among these, 44 were extrahepatic IPNB (E-IPNB) and 59 were intrahepatic IPNB (I-IPNB).
Results
CK20, pancreaticobiliary type, tumor invasion beyond ductal wall, tumor invasion to adjacent organs, and invasive disease were more frequently found in E-IPNB than in I-IPNB (22.7 vs. 8.5%;
p
= 0.043, 38.6 vs. 23.7%;
p
= 0.050, 20.5 vs. 11.9%;
p
< 0.001, 4.5 vs. 1.7%;
p
< 0.001 and 93.2 vs. 55.9%;
p
< 0.001). E-IPNB has poorer 5-year recurrence-free survival (RFS) compared to I-IPNB (51.7 vs. 91.4%;
p <
0.001). There was no significant difference in the rate of initial isolated locoregional recurrence and initial distant recurrence according to tumor location (14.6 in E-IPNB vs. 3.0% in I-IPNB;
p
= 0.123, 19.5 in E = IPNB vs. 12.0% in I-IPNB;
p
= 0.136). Recurrence rate according to timing was different between E-IPNB and I-IPNB: within 1 year (33.3% vs. 83.3%;
p
= 0.061) and 1–3 years (50.0% vs. 0%;
p
= 0.052). The independent prognostic factors for RFS were tumor location (
p
= 0.034) and lymph node metastasis (
p
= 0.013).
Conclusions
E-IPNB has a worse prognosis than I-IPNB. Different follow-up schedules for surveillance according to tumor location are needed after surgery.
Despite an increase in the reports of intraductal papillary neoplasm of the bile duct (IPN-B), the clinical characteristics and long-term prognosis of this disease are not well known compared with ...those of intraductal papillary mucinous neoplasms of the pancreas. The objective of our study was to compare the clinical features, radiologic findings, and clinical outcomes of IPN-B according to histologic subtype.
A retrospective analysis was performed on the medical records of 97 patients diagnosed with IPN-B by pathologic analysis of their surgical specimens between May 1995 and May 2010. We compared the clinical manifestations, radiological findings, pathologic grade, curative resection rate, recurrence, and overall survival according to four histologic subtypes: gastric (n=15), intestinal (n=46), pancreaticobiliary (n=33), and oncocytic (n=3), which were classified on the basis of hematoxylin and eosin staining and the immunohistochemical profile of mucin core proteins.
Mucin hypersecretion was significantly more frequent in patients with gastric and intestinal types than it was in those with oncocytic and pancreaticobiliary types (P=0.014). There were no significant differences between groups regarding the presence of bile duct stones or tumor location. The frequency of invasive carcinoma in the pancreaticobiliary type was significantly higher than those in the gastric and intestinal types (72.7 vs. 26.7 and 32.6%, P<0.001 and P<0.001). When comparing the survival curves according to histologic subtype, patients with pancreaticobiliary type demonstrated significantly worse survival compared to those with gastric and intestinal types (P=0.035).
Gastric and intestinal types of IPN-B have similar clinical characteristics compared with the pancreaticobiliary type, which has a worse prognosis.
Information on the clinicopathologic characteristics of invasive carcinomas arising from mucinous cystic neoplasms (MCNs) is limited, because in many early studies they were lumped and analyzed ...together with noninvasive MCNs. Even more importantly, many of the largest prior studies did not require ovarian-type stroma (OTS) for diagnosis. We analyzed 178 MCNs, all strictly defined by the presence of OTS, 98% of which occurred in perimenopausal women (mean age, 47 y) and arose in the distal pancreas. Twenty-nine (16%) patients had associated invasive carcinoma, and all were female with a mean age of 53. Invasion was far more common in tumors with grossly visible intracystic papillary nodule formation ≥1.0 cm (79.3% vs. 8.7%, P=0.000) as well as in larger tumors (mean cyst size: 9.4 vs. 5.4 cm, P=0.006); only 4/29 (14%) invasive carcinomas occurred in tumors that were <5 cm; however, none were <3 cm. Increased serum CA19-9 level (>37 U/L) was also more common in the invasive tumors (64% vs. 23%, P=0.011). Most invasive carcinomas (79%) were of tubular type, and the remainder (5 cases) were mostly undifferentiated carcinoma (2, with osteoclast-like giant cells), except for 1 with papillary features. Interestingly, there were no colloid carcinomas; 2 patients had nodal metastasis at the time of diagnosis, and both died of disease at 10 and 35 months, respectively. While noninvasive MCNs had an excellent prognosis (100% at 5 y), tumors with invasion often had an aggressive clinical course with 3- and 5-year survival rates of 44% and 26%, respectively (P=0.000). The pT2 (>2 cm) invasive tumors had a worse prognosis than pT1 (≤2 cm) tumors (P=0.000), albeit 3 patients with T1a (<0.5 cm) disease also died of disease. In conclusion, invasive carcinomas are seen in 16% of MCNs and are mostly of tubular (pancreatobiliary) type; colloid carcinoma is not seen in MCNs. Serum CA19-9 is often higher in invasive carcinomas, and invasion is typically seen in OTS-depleted areas with lower progesterone receptor expression. Invasion is not seen in small tumors (<3 cm) and those lacking intracystic papillary (mural) nodules of ≥1 cm, thus making the current branch-duct intraductal papillary mucinous neoplasm management protocols also applicable to MCNs.
Recent advances in understanding the genetics of pancreatic ductal adenocarcinoma (PDAC) have led to the potential for a personalized approach. Several studies have described the feasibility of ...generating genetic profiles of PDAC with next-generation sequencing (NGS) of samples obtained through endoscopic ultrasound-guided tissue acquisition (EUS-TA). The aim of this study was to find the best EUS-TA approach for successful NGS of PDAC.
We attempted to perform NGS with tissues from 190 patients with histologically proven PDAC by endoscopic ultrasound-guided fine-needle aspiration and endoscopic ultrasound-guided fine-needle biopsy at Samsung Medical Center between November 2011 and February 2015. The medical records of these patients were retrospectively reviewed for parameters including tumor factors (size, location, and T stage), EUS-TA factors (needle gauge G, needle type, and number of needle passes) and histologic factors (cellularity and blood contamination). The sample used for NGS was part of the EUS-TA specimen that underwent cytological and histological analysis.
NGS could be successfully performed in 109 patients (57.4%). In the univariate analysis, a large needle G (p=0.003) and tumor located in the body/tail (p=0.005) were associated with successful NGS. The multivariate logistic regression analysis revealed that the needle G was an independent factor of successful NGS (odds ratio, 2.19; 95% confidence interval, 1.08 to 4.47; p=0.031).
The needle G is an independent factor associated with successful NGS. This finding may suggest that the quantity of cells obtained from EUS-TA specimens is important for successful NGS.
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