INTRODUCTION/OBJECTIVES: Intraductal papillary neoplasm of the bile duct (IPNB) is a relatively new entity characterized by dilation of bile ducts filled with papillary neoplasms, which represents premalignant lesion of cholangiocarcinoma, with common malignant transformation

Herceg, Stjepan

Virović Jukić, Lucija

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CR31 Intraductal papillary neoplasm of the bile duct (IPNB) as an uncommon cause of abdominal pain and cholangitisStjepan Hercega, Lucija Virović Jukićba School of Medicine, University of Zagrebb Department of Gastroenterology and Hepatology, Ses-tre Milosrdnice University Hospital Center, Zagreb, Cro-atiaDOI: https://doi.org/10.26800/LV-144-supl2-CR31 Stjepan Herceg 0000-0001-9543-4482, Lucija Vi-rović Jukić 0000-0002-6350-317XKeywords: bile ducts, cholangiocarcinoma, endoscopic ultrasound (EUS), intraductal papillary, neoplasm, mag-netic resonance cholangiopancreatography (MRCP)INTRODUCTION/OBJECTIVES: Intraductal papillary neo-plasm of the bile duct (IPNB) is a relatively new entity charac-terized by dilation of bile ducts filled with papillary neoplasms, which represents premalignant lesion of cholangiocarcinoma, with common malignant transformation.CASE PRESENTATION: A 75-year-old woman presented to our Department after an episode of dull epigastric pain radi-ating into the chest and the back accompanied by fever and cholestatic liver lesion, which was consistent with an episode of acute cholangitis. A CT scan performed before admission showed dilated intrahepatic bile ducts and hyperdense content within the dilated common bile duct 4 cm proximally to du-odenal papilla that was suspicious of a neoplasm. Therefore, we performed an endoscopic ultrasound (EUS), which also showed dilated common bile duct, mostly filled with echo-genic masses, suspicious of IPNB. During EUS, a fine needle aspiration was performed, and cytological analysis was con-sistent with adenocarcinoma. To assess the extent of bile ducts involvement, a magnetic resonance cholangiopancreatography (MRCP) was performed, which showed beading and dilation of  intrahepatic and both extrahepatic bile ducts including common bile duct, with filling defects forming papillary for-mations in some places. Furthermore, a hypointense mass was found within the common bile duct, confirming a cytology re-port and CT finding of the malignant tumor. The patient is now scheduled for surgery of the IPNB associated cholangiocarci-noma of the distal part of the common bile duct.CONCLUSION: IPNB is a very rare condition and an uncom-mon cause of cholangitis. Thus, timely diagnosis is important for proper treatment.CR32 Invasive Fungal Sinusitis Presenting as Unilateral Vision Loss: A Case ReportLea Jerkića, Kristina Lončarićba School of Medicine, University of Zagrebb Clinical Department of Ophthalmology and Optometry, Sestre Milosrdnice University Hospital CenterDOI: https://doi.org/10.26800/LV-144-supl2-CR32 Lea Jerkić 0000-0002-1361-7996, Kristina Lončarić 0000-0003-0928-7952Keywords: invasive fungal sinusitis, optic neuropathy, sphenoidotomyINTRODUCTION/OBJECTIVES: Invasive fungal sinusitis is a rare condition mainly affecting the immunocompromised. As a result of the invasion of the optic canal, optic neuropathy and subsequent vision loss can develop.CASE PRESENTATION: A 76-year-old female presented for an ophthalmologic consultation complaining of a three-week history of vision loss in the right eye. She also had right-sided temporal and periauricular headaches for the last two months. Her medical history was remarkable for diabetes mellitus type II, hyperlipidemia, hypertension, cerebrovascular insult with right hemiparesis, internal carotid artery stenosis and stage III B-cell chronic lymphocytic leukemia. The ophthalmic history was remarkable for cataract surgery and nonproliferative dia-betic retinopathy. Her best-corrected visual acuity at presen-tation was 0.125 in the right eye and 1.0 in the left eye with a positive right relative afferent pupillary defect. Ophthalmo-scopic examination revealed right optic disc pallor. Optical co-herence tomography of the optic nerve head, visual field tests, and neuroimaging were performed. Computed tomography revealed a right sphenoid sinus filled with hyperdense mass, sclerotic bony walls with erosion, and discontinued sphenoidseptum, central wall, roof, and medial optic canal which was indicative of chronic invasive fungal sinusitis. The patient un-derwent sphenoidotomy to remove the mycotic mass. The pa-tient's vision did not recover.CONCLUSION: The diagnosis of invasive fungal sinusitis should be suspected in predisposed patients with sinusitis and vision loss or ophthalmoplegia. Due to delays in the diagnosis, it is often too late to save or improve the vision.17th Croatian Student Summit Liječ Vjesn 2022; godište 144; (Supl. 2)60CASE REPORTS

Intraductal papillary neoplasm of the bile duct (IPNB) as an uncommon cause of abdominal pain and cholangitis

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