PTs are typically benign and can

PTs are typically benign and can be cured through wide excision with histologic margins negative for malignant cells. A histologic margin of at least 1 cm has been reported in previous studies. The stromal component may undergo malignant transformation; hence, the misleading traditional term cystosarcoma phyllodes. However, it is rare for epithelia to undergo such a change, which usually occurs in cases of malignant PTs. The patient in this study exhibited a rapidly enlarging left breast mass corresponding to the clinical course of PTs. The mammography revealed a high-density mass with an obscured margin and the sonography revealed a well-defined, lobulated, and hypoechoic mass, which constitute typical findings of a PT. However, PTs are difficult to distinguish from other tumors on the basis of clinical history and radiologic features. Treatment of these rare cases should be tailored to address the PTs and invasive carcinomas individually. PTs are treated through wide excision, and invasive carcinomas should be treated using a method including sampling/dissection of the axillary lymph nodes as well as adjuvant therapy based on the pathologic stage, tumor phorbol myristate acetate receptor, progesterone receptor, and HER2/neu status. Lenhard et al reported the local recurrence of borderline PT to be 20%. The prognosis of invasive ductal carcinoma is based on the classification of conventional histology and immunohistochemistry. Currently, there is little consensus on the prognosis of this rare disease.
Introduction Intraductal papillary neoplasm of the bile duct (IPNB) has been defined as a “biliary epithelial tumor with exophytic nature exhibiting papillary mass within the bile duct lumen and with prominent intraductal growth pattern”. The most common manifestations are abdominal pain, jaundice, and cholangitis; however, hemobilia has occasionally been observed. Definitive clinical and radiological diagnosis is difficult in IPNB. Because malignant components are present in over half of all IPNB cases, a complete surgical resection is typically necessary. In this article, we report the surgical treatment of an IPNB presenting as recurrent hemobilia.
Case report A 74-year-old man with a 2-year history of recurrent upper gastrointestinal (GI) bleeding and cholangitis presented with epigastric pain, jaundice, and tarry stool. On examination, he had icteric sclera, pale conjunctiva, and local epigastric tenderness. Laboratory tests revealed that the serum bilirubin and hemoglobin levels were 3 mg/dL and 10.2 g/dL, respectively. An upper GI endoscopy revealed a large blood clot in the second portion of the duodenum near the papilla of Vater. Angiography did not show any vascular lesion from the branches of the celiac trunk and superior mesenteric artery. Abdominal ultrasonography and contrast-enhanced computed tomography (CT) revealed bilateral intrahepatic biliary tree dilatation with no intrahepatic lesion. Endoscopic retrograde cholangiopancreatography revealed bilateral intrahepatic biliary tree dilatation with filling defects in the distal common bile duct (CBD); although a few stone fragments were extracted, the filling defects remained. Choledochoscopy revealed minimal blood clotting in the CBD and some blood flow from the left intrahepatic duct; a T-tube was placed in the CBD after removing the clot, but after 1 month, a filling defect was observed again in the left intrahepatic duct (Fig. 1). Contrast-enhanced CT revealed a hyperdense lesion in the left lateral liver segment (Fig. 2), which was subsequently resected. Grossly, intrahepatic bile ducts were markedly dilated and a papillary tumor measuring 1.0 cm × 0.9 cm × 0.8 cm was observed along with an atrophic and fibrotic appearance of periductal liver parenchyma (Fig. 3). Microscopically, a focal low-grade IPNB (Fig. 4A) was evident along with markedly dilated bile ducts, granulation tissue, and vessel rupture (Fig. 4B). The histopathological diagnosis was pancreaticobiliary-type IPNB (Fig. 4C). The postoperative course was uneventful, and the patient was discharged on postoperative Day 7; no recurrence was observed at the 1-year follow-up examination.