1. Intraductal Implantation of Biliary Neoplasms: A Potential Cause of "Multifocal" Tumors.
- Author
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Zen Y, Akita M, Florou E, Fukumoto T, Itoh T, Prassas E, Menon K, and Srinivasan P
- Subjects
- Humans, Male, Female, Aged, Middle Aged, Neoplasms, Multiple Primary pathology, Neoplasms, Multiple Primary genetics, Neoplasms, Multiple Primary surgery, Neoplasms, Second Primary pathology, Neoplasms, Second Primary genetics, Aged, 80 and over, Mutation, Immunohistochemistry, High-Throughput Nucleotide Sequencing, Bile Duct Neoplasms genetics, Bile Duct Neoplasms pathology, Bile Duct Neoplasms surgery, Cholangiocarcinoma genetics, Cholangiocarcinoma pathology, Cholangiocarcinoma surgery, Biomarkers, Tumor genetics, Biomarkers, Tumor analysis
- 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., Competing Interests: Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
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