Biliary Papillomatosis: Clinical, Cholangiographic and Cholangioscopic Findings

Kim, Y. S.; Myung, Sung-Jae; Kim, S. Y.; Kim, H. J.; Kim, J. S.; Park, E. T.; Lim, Byeong Cheol; Seo, Dong Wan; Lee, S. K.; Kim, M. H.; Min, Young Il

doi:10.1055/s-2007-1001418

Cited by 66 publications

(61 citation statements)

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“…Some cases of biliary papillomatosis have multiple tumors at the same time, and others manifest asynchronous tumors at different sites of the biliary tract. 1,2 Biliary papilloma and papillomatosis are now thought to be pre-malignant lesions, and they have the potential to progress to invasive lesions via an adenomacarcinoma sequence. 3 Some cholangiocarcinomas show mainly papillary proliferation in the bile duct lumen, and those cases are designated as papillary cholangiocarcinoma (papillary-CC) or cholangiocarcinoma of the intraductal growth-type.…”

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confidence: 99%

Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas

Zen¹,

Fujii²,

Itatsu³

et al. 2006

Hepatology

344

349

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Recently, attention has been drawn to papillary neoplasm of the pancreatobiliary systems. In the pancreas, the disease entity of intraductal papillary mucinous neoplasm (IPMN-P) is widely recognized. In contrast, the pathological characteristics of biliary papillary tumors, such as biliary papilloma(tosis) and papillary cholangiocarcinoma, have not yet been well documented. In this study, we compared the pathological features and post-operative prognosis among biliary papillary tumors (10 cases of biliary papilloma(tosis) and 22 cases of papillary cholangiocarcinoma), conventional non-papillary cholangiocarcinoma (15 cases), and IPMN-P (31 cases). Macroscopically, all biliary papillary tumors were characterized by the prominent intraductal papillary proliferation, and macroscopic mucin-hypersecretion was seen in 9 of 32 cases (28%). Histologically, biliary papillary tumors consisted of three types of tumor cells (pancreaticobiliary, intestinal and gastric types), whereas only the pancreaticobiliary type was observed in non-papillary cholangiocarcinoma. Immunohistochemically, biliary papillary tumors were characterized by the common expression of MUC2, CDX2 and cytokeratin 20. In addition, biliary papillary tumors could be associated with two types of invasive lesions: tubular adenocarcinoma (9 cases) and mucinous carcinoma (5 cases). Patients with tubular adenocarcinoma had a poor prognosis compared to non-invasive papillary tumor or papillary tumor with mucinous carcinoma. These pathological characteristics and the survival status of biliary papillary tumors were different from those of non-papillary cholangiocarcinoma, and rather closely resembled those of IPMN-P. C ertain types of papillary tumors with different malignant potentials are known to occur in the intrahepatic and extrahepatic bile ducts. 1 Biliary papilloma (papilloma adenoma) is a rare benign neoplasm composed of papillary proliferation of the dysplastic biliary epithelium with delicate fibrovascular stalks. 1 Multiple recurring biliary papillomas are known as biliary papillomatosis. Some cases of biliary papillomatosis have multiple tumors at the same time, and others manifest asynchronous tumors at different sites of the biliary tract. 1,2 Biliary papilloma and papillomatosis are now thought to be pre-malignant lesions, and they have the potential to progress to invasive lesions via an adenomacarcinoma sequence. 3 Some cholangiocarcinomas show mainly papillary proliferation in the bile duct lumen, and those cases are designated as papillary cholangiocarcinoma (papillary-CC)

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mentioning

confidence: 99%

Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas

Zen¹,

Fujii²,

Itatsu³

et al. 2006

Hepatology

344

349

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“…9 The second is an intraductal papillary neoplasm of the bile duct (biliary IPN), which is a macroscopic lesion characterized by prominent papillary proliferation of dysplastic epithelium with frequent intestinal metaplasia and mucin hypersecretion. [11][12][13][14] Biliary IPN is now regarded as the biliary counterpart of pancreatic intraductal papillary mucinous neoplasm. [15][16][17] These two lesions are different in their pathological and clinical characteristics.…”

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Biliary intraepithelial neoplasia: an international interobserver agreement study and proposal for diagnostic criteria

et al. 2007

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Cholangiocarcinoma of the intrahepatic and extrahepatic bile ducts develops through a multistep histopathologic sequence. Premalignant or non-invasive neoplastic lesions of bile ducts have been historically called biliary dysplasia or atypical biliary epithelium. To this date, no standard terminology or classification system has been offered for these lesions. In 2005, a conceptual framework and diagnostic criteria for biliary intraepithelial neoplasia (BilIN) were proposed using the livers of patients with hepatolithiasis. We report herein an international interobserver agreement study on the diagnosis of biliary non-invasive neoplastic lesions with the goal to obtain a consensus on the terminology and grading. Seventeen pathologists from the United States, Europe and Asia participated in this study. They shared a digital file containing histological pictures of 30 foci of non-invasive neoplastic lesions selected from the biliary system of patients suffering from primary sclerosing cholangitis, choledochal cyst or hepatolithiasis. In the criteria, we proposed in 2005, BilIN was classified into three categories based on the degree of atypia: BilIN-1, BilIN-2 and BilIN-3. In this study, consensus was reached for the terminology of BilIN and the three-grade classification system. Interobserver agreement on the diagnosis was moderate (j-value ¼ 0.45). On the basis of the suggestions and opinions obtained from the 17 participants, the original criteria for BilIN were revised. We now propose a new consensus classification of BilIN that may assist in allowing a more uniform terminology for the diagnosis of biliary noninvasive neoplastic lesions. This classification should help to advance clinical and research applications. Keywords: biliary dysplasia; BilIN; intrahepatic cholangiocarcinoma; cholangiocarcinoma; bile duct Specialties such as gynecology, urology and gastroenterology are facing difficult dilemmas when trying to incorporate 'preneoplastic lesions' into management recommendations that may vary from observa-

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“…BP is less invasive, rarely metastasizes to the lymph node than cholagiocarcinoma [18][19][20], and rarely involved concomitantly in the extrahepatic biliary tract and pancreatic duct [1,12,13,21] Complete local resection of the involved biliary tract according to the rules of surgical oncology is an acceptable form of treatment with comparable outcomes and markedly decreased morbidity compared with pancreatoduodenectomy [22][23][24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Left hemihepatectomy and caudate lobectomy and complete extrahepatic bile duct resection using transduodenal approach for hilar cholangiocarcinoma arsing from Biliary Papillomatosis

Kim

Hwang

Park

et al. 2008

Journal of Surgical Oncology

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Biliary Papillomatosis: Clinical, Cholangiographic and Cholangioscopic Findings

Cited by 66 publications

References 0 publications

Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas

Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas

Biliary intraepithelial neoplasia: an international interobserver agreement study and proposal for diagnostic criteria

Left hemihepatectomy and caudate lobectomy and complete extrahepatic bile duct resection using transduodenal approach for hilar cholangiocarcinoma arsing from Biliary Papillomatosis

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