Diagnosing Intraductal Papillary Mucinous Neoplasm of the Bile Duct with Computed Tomography: A Clinical Case Analysis
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摘要:
目的：探讨肝脏胆管导管内乳头状黏液性肿瘤（IPMN-B）的CT特征。方法：回顾性分析3例经手术病理证实为IPMN-B患者的临床资料、CT表现，并复习文献。结果：3例IPMN-B的CT表现为类圆形囊性病灶，病灶内可见实性附壁结节或带蒂的乳头状软组织密度影，病灶与胆管相通，周边胆管可见不同程度扩张。增强扫描3例病灶内实性成份轻−中度不均匀强化，囊性成份未见强化。其中1例IPMN-B患者4年内3次复查，病灶逐渐增大并恶变；3例肝周及腹膜后均未见淋巴结肿大。结论：肝内胆管内乳头状肿瘤特征性的CT表现为边界清晰的囊性病灶，伴有实性壁结节或肿块，大部分病灶与胆管相通并伴有胆管扩张。
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关键词:
- CT /
- 胆管导管内乳头状黏液性肿瘤 /
- 诊断
Abstract:Objective: This study aimed to explore the computed tomography (CT) features of the intraductal papillary mucinous neoplasm of the bile duct (IPMN-B). Methods: A retrospective analysis was conducted on the clinical data and CT findings of three patients with surgically and pathologically confirmed IPMN-B. Additionally, a review of the relevant literature was performed. Results: All three IPMN-B cases exhibited well-defined circular cystic lesions on CT cans. These lesions contained solid mural nodules or soft tissue densities with visible pedicles within the cysts. Notably, the lesions connected to the bile duct, and surrounding bile ducts showed varying degrees of dilation. Enhanced CT scans revealed mild to moderate uneven enhancement within the solid components of all three lesions, while the cystic components displayed no enhancement. Interestingly, one patient with IPMN-B underwent follow-up examinations over four years, demonstrating gradual enlargement and malignant transformation of the lesion. None of the three cases showed lymph node enlargement around the liver or retroperitoneum. Conclusion: The study suggests characteristic CT features of IPMN-B. These include well-defined cystic lesions with accompanying solid wall nodules or masses. Additionally, most lesions connect to the bile duct and are accompanied by bile duct dilation.
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图 1 患者男性，74岁，胆管导管内黏液性肿瘤伴上皮低级别异形增生
注：（a）CT平扫示肝左叶胆管近肝门部明显扩张（箭头），其内见一低密度软组织肿块（细箭）；（b）增强扫描门脉期，病灶中度强化（细箭），其上游胆管扩张（箭头），扩张胆管与病灶液性成分相通（黑箭）；（c）增强扫描门脉期示，肝左叶萎缩，扩张胆管内肿块（细箭）；（d）MRCP直观显示肝门部肝左叶胆管梭形扩张；（e）病理示含黏液的柱状肿瘤上皮细胞围绕血管轴心排列成乳头状突入胆管，肿瘤细胞内含大量嗜酸性细胞质，核低度异形（HE×100）。
Figure 1. Male patient, 74 years old, with IPMN-B and low-grade epithelial dysplasia
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图 2 患者男性，65岁，胆管导管内黏液性肿瘤伴上皮高级别异形增生
注：（a）CT平扫，肝右前叶胆管明显扩张，其内见多发乳头状软组织影（黑箭），并见近似液体密度影（白箭）及其上方更低液性密度影（白箭头），两者间隐约见液平影；（b）增强动脉期，乳头状软组织影强化（黑箭），近似液体密度影（白箭）及其上方更低液性密度影（白箭头）均未见强化；（c）增强门脉期及（d）冠状位，胆管内多发乳头状软组织影持续强化（黑箭），近似液体密度影（白箭）及其上方更低液性密度影（白箭头）仍无强化，病灶上游肝左叶胆管扩张（黑箭头）；（e）病理示胆管导管内黏液性肿瘤，伴上皮高级别异形增生。
Figure 2. Male patient, 65 years old, with IPMN-B and epithelial high-grade dysplasia
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图 3 患者女性，64岁，胆管导管内黏液性乳头状腺癌
注：（a）2012年平扫横断位肝右叶近肝门部见胆管扩张，扩张胆管内见软组织影（黑箭）；（b）2012年增强扫描动脉期病灶轻度强化（黑箭），液性成分未见强化（白箭），与胆管相通；（c）2012年延迟期病灶进一步强化，可见病灶蒂部与胆管壁相连（黑箭），液性成分与胆管相通（白箭）；（d）2012年平衡期冠状位病灶不均匀强化（黑箭），不成比例扩张的胆管（白箭）；（e）2014年轴位平衡期图像，对比2012年图像，病灶明显扩大（黑箭），胆管扩张亦较前明显，其上游开始出现胆管扩张（黑箭头），病灶边缘出现小钙化点（白箭）；（f）2016年轴位门脉期图像，对比2014年图像，病灶稍扩大（黑箭），胆管扩张进一步明显，现其上下游均出现胆管扩张（黑箭头），病灶边缘钙化灶较前增多、增大（白箭）。
Figure 3. Female patient, 64 years old, with IPMN-B
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