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Reminder of important clinical lesson
Case report
Intraductal papillary neoplasm of bile duct: all rare in one
  1. Aprajita Chaturvedi1,
  2. Manjunath Maruti Pol1,
  3. Kirti Jangra2 and
  4. Priyanka Singh3
  1. 1Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, Delhi, India
  2. 2Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
  3. 3Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Manjunath Maruti Pol; manjunath.pol{at}gmail.com

Abstract

A 45-year-old woman was referred from Department of Dermatology to Surgery outpatient department with pruritus since 6 months and an episode of jaundice that lasted for 15 days about 6 months ago. She was referred with a contrast-enhanced MRI finding that showed a small lesion in the lower end of common bile duct. Endoscopy-guided biopsy was performed twice at our hospital, the second revealed low grade dysplasia. Consequently, she underwent pancreaticoduodenectomy. Intraoperatively, there were both vascular and biliary anatomical variations that were missed on preoperative images. On histopathological examination, it turned out to be a mixed variety of intraductal papillary neoplasm of bile duct (IPNB). As all findings were rare in one, hence, we present this case of IPNB that presented to us with variable clinical, radiological, surgical and pathological findings.

  • biliary intervention
  • pancreas and biliary tract
  • gastrointestinal surgery
  • general surgery

https://doi.org/10.1136/bcr-2020-237001

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    Footnotes

    • Contributors MMP conceived the design. MMP was the first operating surgeon; Patient was evaluated, worked up and discussed by AC. PS was involved in radiological discussion and arriving at diagnosis.KJ was involved in histopathological examination of the specimen. Patient was operated by MMP. MMP and AC collected the operating steps. Demography of the patient, clinical details and video editing was done by AC, PS and KJ and further it was analysed by MMP. Manuscript was prepared by MMP, AC, PS and KJ. Editing of image was performed by AC and MMP. Case report was written, critically analysed, revised and uploaded by MMP. Responses to the reviewers was written by MMP after consulting radiology faculty. Final approval of the case report is provided by MMP, AC, PS and KJ. Overall responsibility and corresponding author is MMP.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.