A Case of Diffuse Papillomatous Cholesterosis of the Gallbladder with Congenital Dilatation of the Bile Duct Associated with Anomalous Arrangement of the Pancreatobiliary Duct

Kimi Yamauchi, Tomoyuki Miyata, Yasunobu Furusawa, Tomohiro Mizutani, Masahiro Toyama, Hisakazu Kawai, Kazuo Kato and Takehiko Miyasita^*

Department of Surgery and Department of Pathology^*, Gifu Prefectural Gero Hot Spring Hospital

A 76-year-old man admitted due to upper abdominal pain was found in abdominal ultrasonography to have wall thickness and multiple polypoid lesions of the gallbladder. Magnetic resonance cholangiopancreatography showed dilatation of the superior bile duct and multiple small defects of the gallbladder. Percutaneus transhepatic biliary drainage showed dilatation of the cystic duct and a long narrow segment of inferior bile duct. Total amylase concentration of gallbladder bile was 17,097 IU/l. Anomalous arrangement of the pancreatobiliary duct was determined by endoscopic retrograde cholangiopancreatography. We conducted cholecystectomy and choledochectomy. The resected gallbladder had multiple polypoid lesions on the mucosal surface and histologically confirmed many foamy cells in the lamia propria, leading to a diagnosis of diffuse papillomatous cholesterosis with congenital dilatation of the bile duct associated with anomalous arrangement of the pancreatobiliary duct. This was the ninth case found in Japan of diffuse papillomatous cholesterosis and the third with congenital dilatation of the bile duct associated with anomalous arrangement of the pancreatobiliary duct. Diffuse papillomatous cholesterosis suggests a close relationship with anomalous arrangement of the pancreatobiliary duct and it is important to distinguish this from gallbladder carcinoma.

Key words
anomalous arrangement of the pancreaticobiliary duct, congenital dilatation of the bile duct, papillomatous cholesterosis of the gallbladder

Reprint requests
Kimi Yamauchi Department of Surgery, Gifu Prefectural Gero Hot Spring Hospital 1162 Kouden, Gero-cho, Masita-gun, Gifu, 509-2292 JAPAN

Accepted
December 12, 2001

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