Pathology Outlines - Biliary intraepithelial neoplasia Biliary intraepithelial neoplasia (BilIN) is a microscopic, premalignant, noninvasive neoplastic lesion of gallbladder or bile duct Classification is based on highest degree of cytologic atypia BilIN represents the biliary counterpart of pancreatic intraepithelial neoplasia (PanIN)
Pathology Outlines - Dysplasia Rare; found incidentally in 1 - 5% of cholecystectomies (Ann Diagn Pathol 2018;37:7) Follows gallbladder carcinoma trends but with slightly younger age (early sixth decade) (J Surg Res 2014;189:17, Ann Diagn Pathol 2018;37:7)
Intraductal papillary neoplasm of the bile ducts Biliary intraepithelial neoplasia (BilIN): Also is located within lumen of large intrahepatic bile ducts Typically is < 3 mm in height (not mass forming) Simple cyst, simple hepatic cyst, simple biliary cyst, bile duct cyst: Lacks papillary projections Intraductal tubulopapillary neoplasm of the bile duct (Mod Pathol 2015;28:1249):
WHO reporting system for pancreaticobiliary cytopathology High grade biliary intraepithelial neoplasia (BilIN) sampled by brushing (not high grade PanIN) Average ROM: 92 1% Management: reassess or repeat sampling; perform ancillary testing (may refer for surgery if positive FISH or loss of SMAD4 staining); consult experts Category VI: positive for malignancy
WHAT’S NEW IN PATHOLOGY? - PathologyOutlines. com neoplasia (BilIN) is now two tier (low and high grade) rather than three tier Pancreas • Acinar cystadenoma is officially renamed acinar cystic transformation • national conferences and maintains Pancreatic intraepithelial neoplasia (PanIN) is now two tier Numerical grading (PanIN-1A, etc ) is no longer used
Pathology Outlines - Primary biliary cholangitis 2 out of 3 of the following criteria are required: Serum alkaline phosphatase > 1 5 times the upper limit of normal, antimitochondrial antibody, liver sample showing nonsuppurative destructive cholangitis and destruction of interlobular bile ducts (Autoimmun Rev 2014;13:441)
Pathology Outlines - Carcinoma of extrahepatic bile ducts Rare malignant adenocarcinoma arising from extrahepatic bile ducts Biliary adenocarcinomas (cholangiocarcinomas) typically divided into intrahepatic bile duct origin, gallbladder origin, perihilar bile origin (this topic) and distal extrahepatic bile duct origin (this topic), including right and left hepatic ducts, common hepatic duct and common bile duct
Pathology Outlines - Bile duct adenoma 18 month old boy with a large (10 cm) exophytic solid liver tumor (World J Gastrointest Surg 2019;11:414) 35 year old woman with resolution of bile duct adenomas after discontinuing oral contraceptive pills (Middle East J Dig Dis 2016;8:327)