PDF(Pubmed)
Abstract：
A 29-year-old woman was admitted to our hospital for examination of obstructive jaundice and an extrahepatic bile duct lesion. Contrast-enhanced computed tomography revealed a 20 mm cystic lesion with a thin external capsule in the common hepatic duct. Cholangioscopy revealed translucent oval masses with capillary vessels attached to the bile duct walls. The surface was mostly smooth yet partially irregular with redness, suggesting that the masses were epithelial neoplasms. Histological findings of cholangioscopy-guided targeted biopsies of the mass showed subepithelial spindle cell proliferation with no atypical epithelium. The patient underwent an extrahepatic bile duct resection to confirm the pathological diagnosis. Immunohistochemistry of surgical specimens revealed that the spindle cells were positive for estrogen and progesterone receptors. Finally, the cystic lesion with ovarian-like stroma was diagnosed as a mucinous cystic neoplasm with low-grade intraepithelial neoplasia. This is the first report of cholangioscopic imaging of a biliary mucinous cyctic neoplasm. Cholangioscopic imaging can be helpful in the differential diagnosis of biliary neoplasms and in the determination of treatment strategies.
摘要：
一名29岁的妇女被送往我们医院检查阻塞性黄疸和肝外胆管病变。对比增强计算机断层扫描显示，总肝管有20毫米的囊性病变，外囊薄。胆管镜检查显示半透明的椭圆形肿块，毛细血管附着在胆管壁上。表面大部分光滑，但部分不规则，有红色，提示肿块是上皮肿瘤。胆管镜检查引导的肿块靶向活检的组织学发现显示上皮下梭形细胞增殖，没有非典型上皮。患者接受了肝外胆管切除术以证实病理诊断。手术标本的免疫组织化学显示梭形细胞对雌激素和孕激素受体呈阳性。最后,伴有卵巢样间质的囊性病变被诊断为伴有低度上皮内瘤变的黏液性囊性肿瘤.这是胆道粘液性囊性肿瘤的胆道镜成像的第一份报告。胆道镜成像有助于胆道肿瘤的鉴别诊断和治疗策略的确定。
