Intraductal papillary neoplasm of the bile duct:The new frontier of biliary pathology  

作　　者：Federico Mocchegiani Paolo Vincenzi Grazia Conte Daniele Nicolini Roberta Rossi Andrea Benedetti Cacciaguerra Marco Vivarelli 

机构地区：[1]Department of Experimental and Clinical Medicine,Polytechnic University of Marche,Ancona 60126,Italy [2]Department of Gastroenterology and Transplant,United Hospital of Marche,Ancona 60126,Italy

出　　处：《World Journal of Gastroenterology》2023年第38期5361-5373,共13页世界胃肠病学杂志（英文版）

摘　　要：Intraductal papillary neoplasms of the bile duct(IPNBs)represent a rare variant of biliary tumors characterized by a papillary growth within the bile duct lumen.Since their first description in 2001,several classifications have been proposed,mainly based on histopathological,radiological and clinical features,although no specific guidelines addressing their management have been developed.Bile duct neoplasms generally develop through a multistep process,involving different precursor pathways,ranging from the initial lesion,detectable only microscopically,i.e.biliary intraepithelial neoplasia,to the distinctive grades of IPNB until the final stage represented by invasive cholangiocarcinoma.Complex and advanced investigations,mainly relying on magnetic resonance imaging(MRI)and cholangioscopy,are required to reach a correct diagnosis and to define an adequate bile duct mapping,which supports proper treatment.The recently introduced subclassifications of types 1 and 2 highlight the histopathological and clinical aspects of IPNB,as well as their natural evolution with a particular focus on prognosis and survival.Aggressive surgical resection,including hepatectomy,pancreaticoduodenectomy or both,represents the treatment of choice,yielding optimal results in terms of survival,although several endoscopic approaches have been described.IPNBs are newly recognized preinvasive neoplasms of the bile duct with high malignant potential.The novel subclassification of types 1 and 2 defines the histological and clinical aspects,prognosis and survival.Diagnosis is mainly based on MRI and cholangioscopy.Surgical resection represents the mainstay of treatment,although endoscopic resection is currently applied to nonsurgically fit patients.New frontiers in genetic research have identified the processes underlying the carcinogenesis of IPNB,to identify targeted therapies.

关 键 词：Intraductal neoplasm of the bile duct Bile duct neoplasms CHOLANGIOCARCINOMA Intraductal papilloma Classification Treatment 

分 类 号：R735.8[医药卫生—肿瘤]