From the Archives of the AFIP

Abstract

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.

Acute abdominal pain due to biliary cystadenoma

“…Although biliary cystadenomas are benign tumors, they may recur after excision and have potential to develop into biliary cystadenocarcinoma. Symptoms are usually related to the mass effect of the lesion and consist of intermittent pain or biliary obstruction (1,2).…”

“…Serous and bilious fluid is generally anechoic. Echogenic mural nodules and papillary projections may be present (2,4).…”

“…CT may also reveal septal and capsular calcifications (1,4). Unfortunately there are no specific imaging features that permit reliable differentiation of biliary cystadenoma from cystadenocarcinoma (2).…”

“…They are generally intrahepatic (85%) and occur less commonly in the extrahepatic biliary system and gallbladder. Cystadenomas occur predominantly in middle-aged women (2). The tumor is well defined by a fibrous capsule and lined by cuboidal to columnar epithelium.…”

“…Abdominal pain, obstructive jaundice, palpable mass, nausea and vomiting are common signs and symptoms. Occasionally, the tumor is incidentally discovered (2).…”