Title: Biliary Intraductal Papillary Neoplasm (IPMN-B) and Mucinous Cystic Liver neoplasm with biliary extension: Diagnostic Dilemma
Abstract: Background and Aim: A biliary tract intraductal papillary mucinous neoplasm (IPMN-B), considered a precursor for cholangiocarcinoma, is characterized by intraluminal papillary masses and increased mucin secretion that obstructs and dilates the biliary tree. 1 The rare cystic tumors, mucin cystic neoplasms of the liver (MCN-L), rarely extend into the bile ducts, however there are few case reports. 2 Case Report: 54 Years Male, presented with complaints of recurrent severe epigastric pain, radiating to back, requiring iv analgesia associated with low grade intermittent fever, gradually progressive abdominal distension and yellowish discoloration of eyes and urine (total bilirubin 6.4 and direct was 3.8). CECT Abdomen was suggestive of heterogeneously enhancing soft tissue with mid & upper CBD & CHD & its branches with infiltration of adjacent liver parenchyma in rt lobe of liver with large lesser sac collection. Cytology was suggestive of Intraductal papillary neoplasm. MRCP (2/3/22) was suggestive of bilateral dilated IHBR with enhancing diffusion restricting intraluminal polypoidal lesion in biliary radical of rt lobe, CHD & CBD, likely IPMN-B. The lesser sac collection was drained endoscopically. The patient was planned for Right hepatectomy with Extra hepatic bile duct excision with RYHJ. Conclusion: It is difficult to differentiate between MCN-L, IPMN-B and Cholangiocarcinoma with cystic changes. It may also mimic hepatocellular carcinoma with bile duct invasion, intraductal metastasis.