Intraductal Implantation of Biliary Neoplasms: A Potential Cause of "Multifocal" Tumors.

IF 4.5 1区 医学 Q1 PATHOLOGY
American Journal of Surgical Pathology Pub Date : 2024-11-01 Epub Date: 2024-07-01 DOI:10.1097/PAS.0000000000002279
Yoh Zen, Masayuki Akita, Evangelia Florou, Takumi Fukumoto, Tomoo Itoh, Evangelos Prassas, Krishna Menon, Parthi Srinivasan
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Abstract

Multiple biliary tumors rarely develop in patients without underlying chronic hepatobiliary disease. Those lesions are regarded as multifocal neoplasms if there is no interconnecting dysplasia. This study aimed to determine whether 2 separate tumors in the biliary tract represent true multifocal independent tumorigenesis or intraluminal implantation of a single neoplasm. Two separate biliary tumors without intervening dysplasia were identified in 9 cases: biliary intraductal papillary neoplasm (IPNB; n=5) and extrahepatic cholangiocarcinoma (n=4). The 2 tumors were histologically similar in all cases. In 5 metachronous cases, the second tumor developed 2 to 13 years after the complete resection of the first tumor. In 4 synchronous cases, 2 separate neoplasms were identified in a surgical specimen. The metachronous presentation was more common in IPNB cases, whereas the synchronous development was more frequent in cholangiocarcinoma cases. The second tumors in 4 metachronous cases (4/5; 80%) and smaller lesions in all synchronous cases (4/4; 100%) were located in a lower part of the biliary. Immunophenotypes of cytokeratins and mucin core proteins were almost identical between the 2 lesions. Next-generation sequencing also confirmed that the 2 neoplasms shared gene mutations involving KRAS , GNAS , APC , BRAF , CTNNB1 , SMAD4 , TP53 , or ARID1A in all cases. In conclusion, multiple biliary tumors without underlying chronic biliary disease are most likely due to intraductal implantation of a single neoplasm. Thick mucinous bile in IPNB and increasing use of trans-ampullary biliary interventions may contribute to this unique form of tumor extension.

胆道肿瘤的导管内种植:多灶性 "肿瘤的潜在病因。
没有慢性肝胆疾病基础的患者很少会出现多发性胆道肿瘤。如果没有相互关联的发育不良,这些病变被视为多灶性肿瘤。本研究旨在确定胆道中的两个独立肿瘤是真正的多灶性独立肿瘤发生,还是单一肿瘤的腔内种植。在9个病例中发现了2个独立的胆道肿瘤,且无相互间的发育不良:胆管内乳头状瘤(IPNB;n=5)和肝外胆管癌(n=4)。在所有病例中,这两种肿瘤在组织学上相似。在5个同步病例中,第二个肿瘤是在第一个肿瘤完全切除后2至13年出现的。在 4 个同步病例中,在手术标本中发现了 2 个不同的肿瘤。在 IPNB 病例中,同步表现更为常见,而在胆管癌病例中,同步发展更为常见。4 个同步病例(4/5;80%)中的第二个肿瘤和所有同步病例(4/4;100%)中的较小病灶均位于胆管下部。两种病变的细胞角蛋白和粘蛋白核心蛋白的免疫表型几乎相同。下一代测序还证实,所有病例中的两种肿瘤都有涉及 KRAS、GNAS、APC、BRAF、CTNNB1、SMAD4、TP53 或 ARID1A 的基因突变。总之,没有慢性胆道疾病基础的多发性胆道肿瘤很可能是由于单个肿瘤的导管内种植所致。IPNB 中粘稠的胆汁以及越来越多地使用经膀胱胆道介入治疗可能会导致这种独特的肿瘤扩展形式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
10.30
自引率
5.40%
发文量
295
审稿时长
1 months
期刊介绍: The American Journal of Surgical Pathology has achieved worldwide recognition for its outstanding coverage of the state of the art in human surgical pathology. In each monthly issue, experts present original articles, review articles, detailed case reports, and special features, enhanced by superb illustrations. Coverage encompasses technical methods, diagnostic aids, and frozen-section diagnosis, in addition to detailed pathologic studies of a wide range of disease entities. Official Journal of The Arthur Purdy Stout Society of Surgical Pathologists and The Gastrointestinal Pathology Society.
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