Biliary Papillomatosis

Abstract

A 76-year-old man was referred to the hospital because of stomach pain, vomiting, and fever persisting for a few days. On physical examination, there was no abdominal tenderness.Initial blood tests revealed normal white cell count and elevated liver aminotransferases (aspartate amino-, and gamma-glutamyl transferase (1328 U/L, normal range <35). Bilirubin was normal. At the emergency unit, computed tomography (CT) was performed showing an infiltrating mass with small rather linear calcifications in the right liver lobe extending through the main bile duct into the pancreatic head. (Fig. 1) Magnetic resonance imaging (MRI) demonstrated a T 2 hyperintense to intermediate intense, T 1 hypointense, diffusion restrictive, complex solid neoplasm with a tubular aspect and slight contrast uptake, extending from the main bile duct into the right intrahepatic bile ducts. There is focal invasion into the cystic duct and the gallbladder. (Fig. 2) The differential diagnosis includes biliary papillomatosis, polypoid cholangiocarcinoma and hepatocellular carcinoma with intraductal growth. Surgery was performed with peroperative histology of frozen samples showing papillary carcinoma. Paraffin embedded samples showed dysplastic epithelium of the bile ducts with diffuse papillary proliferations. There are atypical columnar cells and only slight development of fibrovascular structures. The epithelium shows ulcerations and a high grade of dysplasia with hyperchromatic nuclei and a large number of mitotic figures. There Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging.Address reprint requests to: Lieve Braeye, M.D., Half Daghmael 6 bus 301,

Intrahepatic Biliary Papillomatosis: A Rare Case Report and Literature Review

“…BP is often clinically challenging to diagnosis before surgery. Conventional trans abdominal ultrasound (TUS), computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde Cholangiography (ERC) and positron emission tomography (PET) have a low specificity to differentiate benign from malignant tumors [6,7]. Transabdominal US and CT often demonstrate non-specific bile duct dilatation, but the ability to visualize small tumors within the ducts is limited.…”

Biliary papillomatosis

“…Biliary papillomatosis is a rare but premalignant condition consisting of numerous biliary papillary adenomas having the tendency to spread superficially along the biliary tree. There is a male predominance (2:1) with a mean age of 50-70 years old (3,4). Two entities are known: the mucin-hypersecreting type (MBP) and a non-mucin producing type (NMBP) (2).…”

“…MRI can demonstrate T2 hyperintense, T1 hypointense, diffusion restrictive intraluminal papillary signal voids. Unfortunately, the sensitivity and specificity of both radiologic and endoscopic methods is low and the differentiation of benign from malignant disease is even more difficult (4,7). However in experienced hands, EUS can diagnose the intraductal papillary masses, possible invasion into the duct wall and pathologically enlarged lymph nodes.…”

“…Biliary papillomatosis was first described by Chappet in 1894 and is characterized by multiple adenomas of variable distribution and extent in the biliary tree (1,2). It mainly affects elderly males and an etiologic association with bile stasis and recurrent biliary tract infection is presumed (3,4). Although the lesions are considered benign, they have a high potential for malignant transformation.…”