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A case of typical IPMN-B with malignant transformation is presented to improve understanding. Case summary: A 67-year-old man developed abdominal pain and jaundice after an initially incidental cystic lesion 4 years earlier. Imaging, duodenoscopy, and ERCP showed progressive lesions and papillary nodules; surgery confirmed high-grade intraepithelial neoplasia with invasive carcinoma. Conclusion: Recognition and vigilance for IPMN-B are essential when “hepatic cysts” or “biliary stones” are incidentally detected.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/intraductal-papillary-neoplasm-of-the-biliary-tract-with-typical-clinicopathological-endoscopic-features-a-case-report/406708/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/intraductal-papillary-neoplasm-of-the-biliary-tract-with-typical-clinicopathological-endoscopic-features-a-case-report/406708.png","ImageObject",300,407,{"name":92,"@type":93},"Jasmine","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is IPMN-B often missed or misdiagnosed?","Question",{"text":113,"@type":114},"Because it lacks specific clinical and imaging manifestations, especially when discovered incidentally, leading to delayed or missed diagnosis and treatment opportunities.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What were the key clinical and laboratory findings in the presented case?",{"text":118,"@type":114},"A 67-year-old man was referred for abdominal pain and jaundice, with mild laboratory increases in inflammatory and liver-related markers while tumour marker levels remained within normal limits.",{"name":120,"@type":111,"acceptedAnswer":121},"How did imaging and endoscopic findings support the diagnosis?",{"text":122,"@type":114},"Imaging showed enlargement of the cystic lesion with enhancing papillary nodules and hyperenhancement in the arterial phase; duodenoscopy revealed a fish-mouth major duodenal papilla with translucent jelly-like mucus, and ERCP showed multiple irregular filling defects.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},406708,1790740791,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},2336478487870,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","| W | J | G | S | World Journal of\u003Cbr>Gastrointestinal Surgery |\n| --- | --- | --- | --- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastrointest Surg 2025 December 27; 17(12): 112887  \nDOI: 10.4240/wjgs.v17.i12.112887 ISSN 1948-9366 (online)  \nCASE REPORT  \nIntraductal papillary neoplasm of the biliary tract with typical clinicopathological, endoscopic features: A case report  \nTian-Yuan Gu, Su-Hang Wang, Shu-Ying Yang, Si-Qi Zhao, Min-Jie Chen, Xiao-Ping Li, Zheng-Wei Song, Xiao-Xia Gu, Fei Chen  \nSpecialty type: Surgery  \nProvenance and peer review:  \nUnsolicited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade B, Grade C, Grade C  \nNovelty: Grade B, Grade B, Grade D  \nCreativity or Innovation: Grade B, Grade C, Grade D  \nScientific Significance: Grade B, Grade C, Grade D  \nP-Reviewer: Guo HD, Chief Physician, Lecturer, China; Tiwari A, MD, Consultant, India  \nReceived: August 8, 2025  \nRevised: October 2, 2025  \nAccepted: October 29, 2025  \nPublished online: December 27, 2025  \nProcessing time: 139 Days and 13.4 Hours  \nTian-Yuan Gu, Si-Qi Zhao, Min-Jie Chen, Xiao-Ping Li, Zheng-Wei Song, Fei Chen, Department of Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China  \nSu-Hang Wang, Department of Pathology, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China  \nShu-Ying Yang, Xiao-Xia Gu, Department of Intensive Medicine, The Second Affiliated Hospital  \nof Jiaxing University, Jiaxing 314000, Zhejiang Province, China Co-first authors: Tian-Yuan Gu and Su-Hang Wang.  \nCo-corresponding authors: Xiao-Xia Gu and Fei Chen.  \nCorresponding author: Fei Chen, PhD, Department of Surgery, The Second Affiliated Hospital of Jiaxing University, No. 1518 Huancheng North Road, Jiaxing 314000, Zhejiang Province, [China.](China. tangchouer@zjxu.edu.cn)[ tangchouer@zjxu.edu.cn](China. tangchouer@zjxu.edu.cn)  \nAbstract  \nBACKGROUND  \nA literature review revealed that intraductal papillary mucinous neoplasm of the biliary tract (IPMN-B) cases with characteristic clinical, imaging, endoscopic, and pathological features are exceedingly rare. Herein, we present a case of typical IPMN-B with malignant transformation that required 4 years for a definitive diagnosis, to enhance the understanding of this disease entity.  \nCASE SUMMARY  \nA 67-year-old male patient was referred to our hospital due to abdominal pain and jaundice. Four years before this admission, a cystic lesion and left hepatolithiasis were incidentally discovered. Laboratory tests revealed mild increases in serum white blood cell count, total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase. Tumour marker levels were within normal limits. Imaging findings demonstrated an enlargement of the cystic tumour from 41 mm to 63 mm, along with the development of numerous enhancing papillary nodules within it, which showed hyperenhancement during the arterial phase. Duodenoscopy revealed an enlarged major duodenal papilla with a fish-mouth appearance and dilated orifice, exuding translucent jelly-like mucus. Endoscopic retrograde cholangiography  \n WJGS  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 27, 2025  Volume 17  Issue 12   \nGu TY et al. IPMN-B with characteristic presentations  \ndemonstrated multiple cloudy, irregular filling defects within the dilated extrahepatic bile duct. Following the diagnosis of IPMN-B, left hepatectomy was performed. Postoperative histopathological examination and immunohistochemistry confirmed IPMN-B with high-grade intraepithelial neoplasia and associated invasive carcinoma.  \nCONCLUSION  \nHeightened vigilance and recognition of IPMN-B are essential when “hepatic cysts” or “biliary stones” are incidentally detected.  \nKey Words: Intraductal papillary n","cbCaiqqulTs2xGSU","https://ap.wps.com/l/cbCaiqqulTs2xGSU","pdf",27919706,"English","# Abstract\n## Background\n## Case summary\n## Conclusion\n# Introduction\n# Case report\n# Conclusion\n# Key words","[{\"question\":\"Why is IPMN-B often missed or misdiagnosed?\",\"answer\":\"Because it lacks specific clinical and imaging manifestations, especially when discovered incidentally, leading to delayed or missed diagnosis and treatment opportunities.\"},{\"question\":\"What were the key clinical and laboratory findings in the presented case?\",\"answer\":\"A 67-year-old man was referred for abdominal pain and jaundice, with mild laboratory increases in inflammatory and liver-related markers while tumour marker levels remained within normal limits.\"},{\"question\":\"How did imaging and endoscopic findings support the diagnosis?\",\"answer\":\"Imaging showed enlargement of the cystic lesion with enhancing papillary nodules and hyperenhancement in the arterial phase; duodenoscopy revealed a fish-mouth major duodenal papilla with translucent jelly-like mucus, and ERCP showed multiple irregular filling defects.\"}]","Intraductal papillary neoplasm of the biliary tract with typical clinicopathological, endoscopic features - A case report | PDF",1790567446,25]