[Multifocal biliary papillomatosis: an indication for liver transplantation]

[Prophylactic surgery for hepatic and biliary tumors]

Benign tumors of the liver and biliary tract are rare entities, and some of them require surgical management to prevent their malignant transformation. Tumors from the biliary tract with malignant potential are treated either by hepatic resection, for mucinous cystic neoplasm and ciliated hepatic foregut cysts, or by biliary resections, for biliary papillary neoplasm and type I and IV choledochal cysts. The pathologies requiring prophylactic cholecystectomy are polyps larger than 10 mm, porcelain gallbladder and pancreaticobiliary maljunction. Finally, hepatocellular adenoma over 5cm, occurring in male patients, or exon 3 mutated beta-catenin, should lead to prophylactic resection by hepatic segmentectomy. This article describes these different pathologies and their management.

A clinical analysis of 11 cases of bile duct adenoma

AIM: To investigate the clinicopathologic features, diagnosis and treatment of bile duct adenoma.

METHODS: The clinical data for 11 patients with pathologically confirmed bile duct adenoma at our hospital were retrospectively analyzed.

RESULTS: This group of patients included 9 females and 2 males. Their age ranged from 25 to 75 years, with an average of 62.2 years. Abdominal pain, jaundice and fever were main clinical manifestations. Diagnosis must rely on histopathological examination. Radical resection of the tumor is the most important treatment owing to the high incidence of malignant transformation. Eight patients had papillary adenoma, and 3 had tubule-papillary adenoma. Six cases were associated with cancer, and four cases had varying degrees of dysplasia. One patient underwent biopsy, and 10 patients underwent radical tumor resection. All patients showed no obvious signs of recurrence throughout the follow-up period.

CONCLUSION: Bile duct adenoma has a high incidence of malignant transformation. It is difficult to diagnose before surgery and is easily misdiagnosed. Diagnosis must rely on histopathological examination. Surgical resection is an effective way to treat the disease with a good prognosis.

Benign biliary papillomatosis in a patient with a choledochal cyst presenting as haemobilia: a case report

Biliary papillomatosis is a rare condition usually detected on imaging or postoperative histopathology. It may be asymptomatic or present with features of cholangitis. We report the management of a patient presenting with haemobilia.

Biliary papillomatosis in three Caucasian patients in a Western centre

INTRODUCTION

Biliary papillomatosis (BP) is a rare condition with a strong potential for malignant transformation and cases from Western centres are sparse.(1) We discuss the presentation, investigation and management of this condition in three Caucasian patients and present a review of the existing literature on BP.

PATIENTS AND METHODS

The case notes of three Caucasian patients with BP who presented to our tertiary referral centre were reviewed. Their case histories, investigations and managements are presented. A search of MEDLINE, PubMed and Cochrane databases was performed to review relevant literature around BP.

DISCUSSION

BP is a rare condition characterised by multiple papillary adenomas involving the biliary tree which lead to recurrent attacks of cholangitis. It is a low-grade neoplasm with high malignant potential and should be regarded as a pre-malignant lesion.

Surgical strategy of biliary papillomatosis in Western countries

Surgical resection, considered the optimal treatment of biliary papillomatosis, often remains incomplete due to high risk of recurrence in view of positive margins or recurrence on the remnant bile duct because of its multifocality. Resection of the whole biliary tree by liver transplantation and duodenopancreatectomy can be regarded as the only curative treatment. However, this approach has resulted in unfavorable results in patients with advanced tumor invasion and/or positive lymph nodes. For the majority of biliary tumors, preoperative assessment is often insufficient. Therefore, we advocate initial partial resection as a first step to eliminate both advanced tumor invasion and/or positive lymph nodes on definitive analysis of the specimen. We propose the strategy of initial resection for selecting the patients who would actually benefit from liver transplantation.

Advances in research on biliary papillomatosis

Biliary papillomatosis is a rare disease that occurs more commonly in elderly males. The usual presentation of this disease is obstructive jaundice or recurrent cholangitis. Characterized by multiple papillary adenomas involving extensive areas of the biliary tree, biliary papillomatosis has a high recurrence rate and a significant risk of malignant transformation. Here, we will review the pathogenesis, clinical features, diagnosis and therapy of biliary papillmatosis.

Papillomatosis of intra- and extrahepatic biliary tree: Successful treatment with liver transplantation

Approximately 60 cases of biliary papillomatosis have been reported in the world literature, while only 6 cases have been reported to be treated with liver transplantation. This rare disease, which is characterized by relapsing episodes of obstructive jaundice and cholangitis that lead to secondary cirrhosis and death from sepsis or liver failure, it is also considered premalignant because of its frequent malignant transformation (25-50%). We present a case of a 43-year-old white man with papillomatosis of intra- and extrahepatic biliary tree who sought care for repeated episodes of obstructive jaundice and cholangitis. The diagnosis was suspected after endoscopic retrograde cholangiopancreatography and confirmed by liver and common bile duct biopsies. The patient underwent orthotopic liver transplantation with Roux-en-Y hepatico-jejunostomy to treat end-stage liver cirrhosis. Fifteen months' follow-up revealed a patient with normal graft function and with no clinically or laboratory findings of disease recurrence or cancer development.