Multidisciplinary Treatment of Aggressive and Rapidly Progressing Biliary Papillomatosis

Ludwig, Leopold; Büchler, Peter; Kleeff, Jörg; Gaa, Jochen; Stangl, Manfred; Prinz, Christian; Langer, Rupert; Frieß, Helmut; Schmid, Roland M.; Algül, Hana

doi:10.1007/s10620-010-1205-6

Cited by 2 publications

(2 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…30 Twenty-two patients with invasive intra-or extrahepatic cholangiocarcinoma without any intraductal papillary components and therefore possibly originating from biliary intraepithelial neoplasia lesions served for comparison. Clinical, demographic and macroscopic information was obtained by review of the medical charts and pathology reports.…”

Section: Patient Selection and Follow Upmentioning

confidence: 99%

Intraductal papillary neoplasms of the bile duct: stepwise progression to carcinoma involves common molecular pathways

Schlitter

Born

Bettstetter³

et al. 2014

Modern Pathology

135

131

View full text Add to dashboard Cite

Intraductal papillary neoplasms of the bile duct are still poorly characterized regarding (1) their molecular alterations during the development to invasive carcinomas, (2) their subtype stratification and (3) their biological behavior. We performed a multicenter study that analyzed these issues in a large European cohort. Intraductal papillary neoplasms of the bile duct from 45 patients were graded and subtyped using mucin markers and CDX2. In addition, tumors were analyzed for common oncogenic pathways, and the findings were correlated with subtype and grade. Data were compared with those from 22 extra-and intrahepatic cholangiocarcinomas. Intraductal papillary neoplasms showed a development from preinvasive low-to highgrade intraepithelial neoplasia to invasive carcinoma. Molecular and immunohistochemical analysis revealed mutated KRAS, overexpression of TP53 and loss of p16 in low-grade intraepithelial neoplasia, whereas loss of SMAD4 was found in late phases of tumor development. Alterations of HER2, EGFR, b-catenin and GNAS were rare events. Among the subtypes, pancreato-biliary (36%) and intestinal (29%) were the most common, followed by gastric (18%) and oncocytic (13%) subtypes. Patients with intraductal papillary neoplasm of the bile duct showed a slightly better overall survival than patients with cholangiocarcinoma (hazard ratio (cholangiocarcinoma versus intraductal papillary neoplasm of the bile duct): 1.40; 95% confidence interval: 0.46-4.30; P ¼ 0.552). The development of biliary intraductal papillary neoplasms of the bile duct follows an adenomacarcinoma sequence that correlates with the stepwise activation of common oncogenic pathways. Further large trials are needed to investigate and verify the finding of a better prognosis of intraductal papillary neoplasms compared with conventional cholangiocarcinoma.

show abstract

Section: Patient Selection and Follow Upmentioning

confidence: 99%

Intraductal papillary neoplasms of the bile duct: stepwise progression to carcinoma involves common molecular pathways

Schlitter

Born

Bettstetter³

et al. 2014

Modern Pathology

135

131

View full text Add to dashboard Cite

show abstract

“…Local ablative therapy and curettage, and radical excision with clear resection margins are associated with better survival. 2,4 Accurate localisation and assessment of the extent of disease involvement remains pertinent to an accurate choice of treatment. In a Korean series by Lee et al, 2 curative resection was associated with significantly better survival (60 months in curative resection vs 36 months in palliative surgery group); similar results were demonstrated by another series of 18 cases in China.…”

Section: Discussionmentioning

confidence: 99%

Robotic left hepatectomy and Roux-en-Y right hepatico-jejunostomy for biliary papillomatosis

et al. 2015

View full text Add to dashboard Cite

An 83-year-old male was referred to us for deranged liver function in December 2010. There was mildly elevated bilirubin level of 36 μmol/L, alkaline phosphatase level of 281 μmol/L, and transaminase level of 98 μmol/L. Tumour markers (carcinoembryonic antigen, alpha-fetoprotein, and carbohydrate antigen 19-9) were normal. Ultrasonography revealed a markedly dilated common bile duct (CBD) and intrahepatic ducts with irregular mural lesions.Endoscopic retrograde cholangiopancreatography (ERCP) showed a grossly dilated CBD and intrahepatic ducts filled with thick mucus and multiple large filling defects. Brush cytology revealed atypical cells. A nasobiliary drainage catheter was inserted for biliary decompression. Bilateral percutaneous transhepatic biliary drainage (PTBD) catheters were later inserted due to inefficient nasobiliary drainage.Further evaluation by computed tomographic scan showed dilatation of the whole biliary system with multiple papilloma-like lesions as shown in Figure 1. The presence of mucus in the biliary tree and image findings raised the suspicion of biliary papillomatosis. In order to localise and assess the extent of involvement, intra-operative choledochoscopy was performed via the PTBD tract. The PTBD tract was serially dilated up to 14 Fr to allow passage of a choledochoscope. Multiple biliary papillomas over the left hepatic duct, hilar bifurcation, and upper main bile duct were visualised. The right biliary system, lower CBD, and ampullary region were disease-free. After thorough assessment by intra-operative choledochoscopy, left hepatectomy and main bile duct excision with right hepatico-jejunostomy via robot-assisted laparoscopic approach was performed.The patient was placed in the reverse Trendelenburg position with legs spread apart, and a 5-to 12-mm subumbilical port was inserted with the establishment of carbon dioxide pneumoperitoneum. After diagnostic laparoscopy, five trocars were

show abstract

Multidisciplinary Treatment of Aggressive and Rapidly Progressing Biliary Papillomatosis

Cited by 2 publications

References 8 publications

Intraductal papillary neoplasms of the bile duct: stepwise progression to carcinoma involves common molecular pathways

Intraductal papillary neoplasms of the bile duct: stepwise progression to carcinoma involves common molecular pathways

Robotic left hepatectomy and Roux-en-Y right hepatico-jejunostomy for biliary papillomatosis

Contact Info

Product

Resources

About