Murat ULAŞ, Erdal Birol BOSTANCI, Tülay KEKLİK, İlter ÖZER, Tahsin DALGIÇ, Volkan ÖTER

Intraductal papillary mucinous neoplasm of the extrahepatic biliary duct: Report of a case

Safra kanalının malign intraduktal papiller müsinöz neoplazisi(İPMN) nadir görülen bir hastalıktır.47 yaşında erkek hasta sağ üst kadran ağrısı ve hassasiyet ile başvurdu. Karın tomografisindeintrahepatik ve ekstrahepatik safra yollarında belirgin genişleme ve ekstrahepatik kanal distalindelümen içerisinde kitle saptandı. ERCP yapılarak distal ana safra kanalından fırça biyopsi alındı.Biyopsi sonucunda şiddetli displazi odakları içeren İPMN (karsinoma in-situ) saptandı. Hastaameliyata alınarak ekstrahepatik safra kanalı eksizyonu ve Roux-en-Y hepatikojejunostomiuygulandı. Ameliyat sonrası 7. gün hasta taburcu edildi. Hasta polikliniğimizde düzenli aralıklarlatakip edilmekte olup hastalığında tekrarlama gözlenmemiştir. Distal ekstrahepatik safra kanalıkanserleri arasında papiller neoplazi çok nadir görülen bir türdür. Eğer erken saptanırsa iyiprognoz göstereceğine inanılmaktadır. Safra yolu İPMN de erken tanı ve tam cerrahi eksizyon çokönemlidir.

Ekstrahepatik safra kanalının intraduktal papiller müsinöz neoplazisi: Olgu sunumu

Malignant biliary tract intraductal papillary mucinous neoplasms (BT-IPMN) is a relatively raredisease. A 47-year-old male patient presented with pain and sensitivity on the right upper quadrantof abdomen. Abdominal tomography revealed marked dilatation of the intra-hepatic andextrahepatic bile ducts and polypoid intraluminal mass in the distal extrahepatic bile duct. ERCPwas performed and the distal common bile duct brush biopsy was taken. Biopsy revealed IPMNwith high grade dysplasia (intraductal papillary mucinous carcinoma in-situ). Patient underwentresection of the extrahepatic bile duct with Roux-en-Y hepaticojejunostomy. Patient wasdischarged on postoperative seventh day. He has been regularly followed at our outpatientdepartment with no evidence of recurrence. A very rare variant of bile duct carcinoma is distalextrahepatic bile duct papillary neoplasm. Papillary cholangiocarcinoma is believed to show abetter prognosis if early detected. It is important to make a precise diagnosis of BT-IPMN and toperform complete surgical resection.

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