Biliary obstruction caused by a papilloma of the common hepatic duct.

Cardoza, Jorge I.; Schrumpf, John D.; Skiöldebrand, Claes G.; Gordon, P; Richards, Victor

doi:10.7863/jum.1988.7.8.467

Cited by 9 publications

(8 citation statements)

References 1 publication

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“…Features.-On US images, extrahepatic bile duct adenomas appear as intraluminal, nonshadowing masses that are isoechoic relative to liver parenchyma (Fig 7) (11,12). Proximal intra-and extrahepatic biliary dilatation may also be present.…”

Section: Radiologicmentioning

confidence: 99%

From the Archives of the AFIP

Levy¹,

Murakata²,

Abbott³

et al. 2002

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A diverse spectrum of benign tumors and tumorlike lesions arises from the gallbladder and bile ducts, and despite their diversity, these lesions share common embryologic origins and histologic characteristics. Although these lesions are relatively uncommon, their importance lies in their ability to mimic malignant lesions in these locations. Benign neoplasms are derived from the epithelial and nonepithelial structures that compose the normal gallbladder and bile ducts. The epithelium gives rise to adenomas, cystadenomas, and the unusual condition of biliary papillomatosis. Granular cell tumors, neurofibromas, ganglioneuromas, paragangliomas, and leiomyomas are examples of benign tumors that may originate from nonepithelial structures. Tumorlike lesions are more commonly found in the gallbladder and include xanthogranulomatous cholecystitis, adenomyomatous hyperplasia, cholesterol polyps, and heterotopias. In the clinical setting of a patient with nonspecific abdominal complaints or symptoms of biliary obstruction, the discovery of a gallbladder or bile duct polyp or mass, gallbladder wall thickening, or biliary stricture is most often indicative of malignancy. However, the differential diagnosis should include benign tumors and tumorlike lesions. The preoperative determination of a benign lesion may significantly alter therapy and patient prognosis.

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Section: Radiologicmentioning

confidence: 99%

From the Archives of the AFIP

Levy¹,

Murakata²,

Abbott³

et al. 2002

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“… 16 Moreover, direct visualization of the lesion and its typical hypersecretion of mucus is a typical feature. 17 Lack of motility on irrigation distinguishes this from ductal stone and mucus. Magnetic resonance imaging of biliary papillomatosis has been reported only once in the literature.…”

Section: Discussionmentioning

confidence: 91%

Clinical and radiological features of biliary papillomatosis

Ma¹,

Lu²,

Chau³

et al. 2000

Australasian Radiology

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Biliary papillomatosis is a rare disease with strong potential for malignant degeneration. Diagnosis is often not easy and most are made intraoperatively. In the present study, five patients with biliary papillomatosis admitted between 1990 and 1997 were reviewed. Their clinical presentation, radiological and biochemical findings were analysed. The aim of the study was to discern a set of characteristic features that would enable an early diagnosis. All of the five patients presented with recurrent episodes of acute cholangitis and epigastric pain with raised serum alkaline phosphatase. Imaging modalities including ultrasound, CT, endoscopic retrograde cholangio-pancreatogram, MRI and magnetic resonance cholangio-pancreatogram were reviewed. Salient imaging features included a dilated biliary tree with multiple ill-defined and fuzzy filling defects or endoluminal frond-like mass lesions. In conclusion, biliary papillomatosis is a rare but important cause of biliary obstruction with relapsing cholangitis and obstructive jaundice. With a healthy index of suspicion, the diagnosis can be reached when the above features are available.

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“…One of our cases has been reported previously 1 . On extensive review of the literature, we found another 36 cases making a total of 39 cases of extrahepatic biliary adenomas reported to date 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ( Table1 and Fig. 4 ).…”

Section: Discussionmentioning

confidence: 98%

Adenomas involving the extrahepatic biliary tree are rare but have an aggressive clinical course

et al. 2015

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Biliary adenomas that are usually found in surgically removed gallbladders are rare, but can also occur in the extrahepatic biliary tree. We present a case series of extrahepatic bile duct adenomas at our institution, along with a review of the literature. All three patients with extrahepatic biliary adenomas (two in the common bile ducts, one in the hepatic duct) were female with a mean age of 74 years. On initial presentation, none of the patients had obstructive jaundice but two of the three patients had symptoms of biliary origin. Case 1 is an 85-year-old woman with an incidental biliary dilation seen on chest imaging; endoscopic ultrasound revealed a sessile adenomatous polyp in the distal bile duct. The patient refused surgery and presented with occlusive biliary stricture and jaundice 5 months after initial presentation, with cytology confirming malignant progression. Case 2 is a 78-year-old woman with a history of primary sclerosing cholangitis and who presented with cholangitis, and Gram-negative sepsis. A polypoid lesion was seen on imaging in the common hepatic duct and direct cholangioscopy with biopsies confirmed the presence of adenoma with high grade dysplasia. The patient underwent successful total bile duct resection and hepaticojejunostomy but represented 1 year later with diffuse metastatic disease to the bone, liver, and peritoneum. Case 3 is a 61-year-old woman who presented with symptoms suggestive of gallbladder pathology and was found to have a polypoid bile duct lesion on intraoperative cholangiogram. Endoscopic retrograde cholangioscopy showed an adenomatous polyp with high grade dysplasia involving the distal common bile duct. The patient underwent distal bile duct resection with choledochojejunostomy but presented with jaundice 4 years after surgery. She was found to have adenocarcinoma involving the small bowel in the Roux limb of jejunum and transverse colon. All three patients in our series presented with interval gastrointestinal malignancy and we therefore recommend aggressive surgical intervention and close postoperative surveillance when diagnosis of extrahepatic bile duct adenoma is made.

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Biliary obstruction caused by a papilloma of the common hepatic duct.

Cited by 9 publications

References 1 publication

From the Archives of the AFIP

From the Archives of the AFIP

Clinical and radiological features of biliary papillomatosis

Adenomas involving the extrahepatic biliary tree are rare but have an aggressive clinical course

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