Biliary Intraductal Papillary Neoplasm (IPMN-B) and Mucinous Cystic Liver neoplasm with biliary extension: Diagnostic Dilemma

Background and Aim: A biliary tract intraductal papillary mucinous neoplasm (IPMN-B), considered a precursor for cholangiocarcinoma, is characterized by intraluminal masses increased mucin secretion that obstructs dilates the tree. 1 The rare cystic tumors, neoplasms of liver (MCN-L), rarely extend into bile ducts, however there are few case reports. 2 Case Report: 54 Years Male, presented with complaints recurrent severe epigastric pain, radiating to back, requiring iv analgesia associated low grade intermittent fever, gradually progressive abdominal distension yellowish discoloration eyes urine (total bilirubin 6.4 direct was 3.8). CECT Abdomen suggestive heterogeneously enhancing soft tissue mid & upper CBD CHD its branches infiltration adjacent parenchyma in rt lobe large lesser sac collection. Cytology Intraductal neoplasm. MRCP (2/3/22) bilateral dilated IHBR diffusion restricting polypoidal lesion radical lobe, CBD, likely IPMN-B. collection drained endoscopically. patient planned Right hepatectomy Extra hepatic duct excision RYHJ. Conclusion: It difficult differentiate between MCN-L, IPMN-B Cholangiocarcinoma changes. may also mimic hepatocellular carcinoma invasion, metastasis.