Intraductal papillary neoplasm of the bile duct:The new frontier of biliary pathology

Intraductal papillary neoplasms of the bile duct(IPNBs)represent a rare variant of biliary tumors characterized by a papillary growth within the bile duct lumen.Since their first description in 2001,several classifications have been proposed,mainly based on histopathological,radiological and clinical features,although no specific guidelines addressing their management have been developed.Bile duct neoplasms generally develop through a multistep process,involving different precursor pathways,ranging from the initial lesion,detectable only microscopically,i.e.biliary intraepithelial neoplasia,to the distinctive grades of IPNB until the final stage represented by invasive cholangiocarcinoma.Complex and advanced investigations,mainly relying on magnetic resonance imaging(MRI)and cholangioscopy,are required to reach a correct diagnosis and to define an adequate bile duct mapping,which supports proper treatment.The recently introduced subclassifications of types 1 and 2 highlight the histopathological and clinical aspects of IPNB,as well as their natural evolution with a particular focus on prognosis and survival.Aggressive surgical resection,including hepatectomy,pancreaticoduodenectomy or both,represents the treatment of choice,yielding optimal results in terms of survival,although several endoscopic approaches have been described.IPNBs are newly recognized preinvasive neoplasms of the bile duct with high malignant potential.The novel subclassification of types 1 and 2 defines the histological and clinical aspects,prognosis and survival.Diagnosis is mainly based on MRI and cholangioscopy.Surgical resection represents the mainstay of treatment,although endoscopic resection is currently applied to nonsurgically fit patients.New frontiers in genetic research have identified the processes underlying the carcinogenesis of IPNB,to identify targeted therapies.

Efficacy and prognosis of vacuum-assisted excision for benign intraductal papilloma of breast:A meta-analysis

Objective:To evaluate the safety and effectiveness of vacuum-assisted excision for benign intraductal papilloma of breast.Methods:The databases including PubMed,Embase,Cochrane Library,WangFang,CNIK,VIP and Web of Science were searched by computer,according the inclusion and exclusion criteria after screening of literature.The Cochrane handbook and Newcastle-Ottawa scale was used to evaluate the studies.Then the Review Manager 5.3 software was to used analyze the data.Results:A total of 1016 patients was included in 9 articles.The amount of blood loss in vacuum-assisted surgery was less than that in open surgery[MD=-6.38,95%CI(-9.90,-2.86),P<0.05].The drainage[MD=-2.56,95%CI(-4.97,-0.15,P<0.05]and drainage time[MD=-0.25,95%CI(-0.40,-0.09),P<0.05]in vacuum-assisted surgery was less than that in open surgery.There were also few postoperative complications than that in open surgery[RR=0.43,95%CI(0.29,0.64),P<0.05].Compared with open surgery,the postoperative recurrence rate was lower in vacuum-assisted surgery[RR=0.26,95%CI(0.14,0.49),P<0.05].Last,there was no statistically significant difference in the operative time between vacuum-assisted surgery and open surgery,[SD=-12.82,95%CI(-25.70,0.06),P=0.05].Conclusion:Compared with open surgery,vacuum-assisted excision has the advantages of less blood loss and lower postoperative complications,but the operative time is not statistically significant compared with open surgery.In addition,compared with open surgery in this study,vacuum-assisted excision has the advantages of lower recurrence rate,but it still needs long-term dynamic observation.

Management of Intraductal Papilloma of the Breast Diagnosed on Core Needle Biopsy:Latest Controversies

Intraductal papillomas(IDPs),including central papilloma and peripheral papilloma,are common in the female population.Due to the lack of specific clinical manifestations of IDPs,it is easy to misdiagnose or miss diagnose.The difficulty of dif-ferential diagnosis using imaging techniques also contributes to these conditions.Histopathology is the gold standard for the diagnosis of IDPs while the possibility of under sample exists in the percutaneous biopsy.There have been some debates about how to treat asymptomatic IDPs without atypia diagnosed on core needle biopsy(CNB),especially when the upgrade rate to carcinoma is considered.This article concludes that further surgery is recommended for IDPs without atypia diagnosed on CNB who have high-risk factors,while appropriate imaging follow-up may be suitable for those without risk factors.

飞行员胰头导管内乳头状黏液性肿瘤一例

一、临床资料患者,男性,38岁,轰6飞行员,飞行时间3000 h.患者于2011年4月中旬饱餐后出现腹部饱胀不适,无发热,无明显腹痛、恶心、呕吐,无黑便及体重下降.2011年4月20日来医院就诊,入院查体:一般情况良好,上腹部轻度压痛,余无阳性体征.心电图、腹部超声均正常,腹部核磁未见异常.化验:胰淀粉酶升高,10 000 u/l.逆行胰胆管造影提示胰腺占位性病变.于4月26日行手术切除,肿物大小0.5 cm×0.7cm,病理示低度恶性胰头导管内乳头状黏液性肿瘤.术后未行放疗及化疗,结论:暂时飞行不合格.术后每3个月复查1次,未见异常,仍在随访中.