A Comparison of Hepatic Mucinous Cystic Neoplasms With Biliary Intraductal Papillary Neoplasms  Tao Li, Yuan Ji, Xu–Ting Zhi, Lu Wang, Xin–Rong Yang, Guo–Ming Shi, Wei Zhang, Zhao–You Tang  Clinical Gastroenterology and Hepatology  Volume 7, Issue 5, Pages 586-593 (May 2009) DOI: 10.1016/j.cgh.2009.02.019 Copyright © 2009 AGA Institute Terms and Conditions

Figure 1 US findings of IPN-B. (A) Cystic lesion with echogenic projections along the cyst walls on US. (B) US showed multilocular cystic lesions with marked dilatation of the bile duct (arrows). (C) US showed unilocular cystic lesion communicated with bile ducts (arrows). (D) On cholangiography, the dilated right bile ducts revealed multiple, amorphous filling defects (arrows) and ragged irregularity of the bile duct wall. (E) Choledochoscope showed pinkish or red multiple papillary masses scattered within the bile duct. Panels D and E are from the same IPN-B patient. Clinical Gastroenterology and Hepatology 2009 7, 586-593DOI: (10.1016/j.cgh.2009.02.019) Copyright © 2009 AGA Institute Terms and Conditions

Figure 2 CT findings of IPN-B. (A) Contrast-enhanced CT showed enhancement of the lesion. (B) Multilocular cystic lesions with slightly enhanced projections along the walls. (C) Slight enhancement of the wall (arrow) with projections. (D) Cystic lesion without enhancement in the arterial phase. Clinical Gastroenterology and Hepatology 2009 7, 586-593DOI: (10.1016/j.cgh.2009.02.019) Copyright © 2009 AGA Institute Terms and Conditions

Figure 3 MRI findings of IPN-B. (A) Contrast T1-weighted MRI showed hypointense lesions with nodular enhancement (arrow). (B) The lesion was hyperintense on T2-weighted image. (C) On the precontrast T1-weighted MRI, the cystic lesion was hyperintense and multiseptated. (D) On the enhanced T2-weighted MRI, the lesion was hyperintense compared with the surrounding liver parenchyma. Clinical Gastroenterology and Hepatology 2009 7, 586-593DOI: (10.1016/j.cgh.2009.02.019) Copyright © 2009 AGA Institute Terms and Conditions

Figure 4 Macroscopic appearances of IPN-B. (A) Tumor was confined within the duct wall without invasion into the adjacent liver. (B) A grayish fungating mass with smaller nodules scattered in the duct around it. (C) The intrahepatic duct was lined by a massive papillary proliferation of epithelial cells and bile duct lumen was partly obstructed by mucin. (D) Cystic tumor filled with mucin and soft brown mural nodules. Direct communication with the bile ducts can be seen easily. Clinical Gastroenterology and Hepatology 2009 7, 586-593DOI: (10.1016/j.cgh.2009.02.019) Copyright © 2009 AGA Institute Terms and Conditions

Figure 5 Subtypes of IPN-B. (A) Gastric type showed numerous papillary structures that project into the lumen (H&E staining, 100×). (B) Intestinal type showed papillovillous proliferations of biliary lining cells (H&E staining, 200×). (C) Pancreaticobiliary type showed multiple papillary and villous proliferations of epithelial lining cells. The nuclei are mildly hyperchromatic and the fibrovascular core is thin (H&E staining, 40×). (D) Oncocytic type showed the most predominant cells of the lining epithelium were columnar cells with oncocytic features showing abundant eosinophilic granular cytoplasm and centrally located nuclei with prominent nucleoli (H&E staining, 40×). Clinical Gastroenterology and Hepatology 2009 7, 586-593DOI: (10.1016/j.cgh.2009.02.019) Copyright © 2009 AGA Institute Terms and Conditions

Figure 6 MCN case. (A) Precontrast CT showed one huge round cyst with a small papillary projection (arrow). (B) Contrast-enhanced CT showed no enhancement of the wall. (C) Macroscopic picture showed a more granular appearance and a solid component (arrow); part of the cyst wall appeared thicker. (D) Histologically, the tall columnar epithelial cells lining a mucinous cystadenoma showed no significant atypia with the ovarian-like stroma beneath the epithelium. Clinical Gastroenterology and Hepatology 2009 7, 586-593DOI: (10.1016/j.cgh.2009.02.019) Copyright © 2009 AGA Institute Terms and Conditions