A Case of Biliary Papillomatosis with Focal Adenocarcinoma

Yasuki Hachisuka, Kazuhide Iwakawa, Shinsuke Kajiwara, Hitoshi Tanaka, Yoshihito Ono, Yasuaki Kashu, Hidenori Kiyochi, Kenzo Okada, Toshihiko Sakao and Kenji Kurihara*

Department of Surgery and Pathology*, Uwajima Municipal Hospital

Biliary papillomatosis is a very rare, usually benign biliary tumor. We report a case of biliary papillomatosis with carcinomatous change in the lesion. An asymptomatic 71-year-old woman found to have liver disfunction in a medical examination was admitted and operated on based on a diagnosis of cholangiocarcinoma of the left hepatic lobe by abdominal CT and ERCP. Interoperative cholangioscopy showed that the papillary tumor had occluded the left hepatic duct. It also showed multiple small lesions in the bifurcation of the anterior and posterior hepatic duct and the lower common bile duct. We conducted left hepatic lobectomy and resected the extrahepatic bile duct. Histopathologically the resected specimen showed papillary proliferation of the bile duct epithelium in all multiple lesions from the intra-to the extra-hepatic bile duct. Carcinomatous change was recognized in part of the main left hepatic duct lesion, leading to a diagnosis of cholangiocarcinoma arising in biliary papillomatosis. Diagnosis and the selection of surgical procedures must take into account that carcinomatous change is reported in about 30% of all case reports.

Key words
biliary papillomatosis, adenocarcinoma, cholangiocarcinoma

Reprint requests
Yasuki Hachisuka Department of Surgery, Uwajima Municipal Hospital
1-1 Gotenmachi, Uwajima, 798-8510 JAPAN

Accepted
November 26, 2003

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