Biliary papillomatosis. Case report

Biliary papillomatosis is a disease characterized by multiple papillary tumours of variable distribution and extent in the intrahepatic and/or extrahepatic biliary tree. Papillary carcinoma can develop within these lesions. Because biliary papillomatosis is a rare biliary pathological entity, its clinical features and outcome are not well known. The course of this disease is very prolonged. This diagnostic difficulty is due above all to the problematic distinction between biliary papillomatosis and cholelithiasis. Therapeutic strategy should be decided pre-operatively among resection, transplantation or stent. In many cases surgical strategy is decided during surgery, considering the mass extension, the local infiltration and the patient's age, and, when possible, with the aid of extemporaneous histological examination. Recently we experienced a case of biliary papillomatosis of the common hepatic duct in a 82-year-old man, presented with obstructive jaundice and pain in the right upper quadrant and epigastrium radiated to the ipsilateral scapula. First we made cholecystectomy and we positioned the T-tube. The follow-ups performed with laboratory tests and T-tube cholangiogram showed no jaundice but the filling defect in the common bile duct was still present. So we performed a resection of the common bile duct and an hepatico-jejunostomy at the hepatic pedicle. The histological examination showed a villous adenoma of the common bile duct with high-grade dysplasia.