낭성 담도 확장을 동반한 담도 유두종증 1예 = A Case of Biliary Papillomatosis with Cystic Dilatation of Bile Duct

다국어 초록 (Multilingual Abstract)

A 61-year-old male who complained of right upper quadrant pain was referred to the authors for evaluation after his computed tomography suggested biliary adenocarcinoma. The lesion consisted of multiple cysts with papillary mass and peri-ampullay mass. The patient underwent an operation due to a clinical suspicion of biliary cystadenocarcinoma, but the pathology confirmed biliary papillomatosis(BP) after diagnosing intrahepatic papillary neoplasm with high-grade dysplasia and invasive adenocarcinoma with papillary neoplasm from the distal common bile duct to the duodenum. BP is a disease characterized by multiple papillary masses. Its cause has yet to be discovered. It commonly manifests as bile duct dilation but rarely as a ductal cystic change. Under computed tomography or magnetic resonance imaging, both the BP and the cystic neoplasm can show bile duct dilation and a papillary mass, which makes their differential diagnosis difficult. A confirmative diagnosis can be made through a pathologic examination. BP is classified as a benign disease that can become malignant and may recur, though rarely. Its treatment of choice is surgical resection. Laser ablation or photodynamic therapy can be used for unresectable lesions. In the case featured in this paper, biliary papillomatosis was difficult to differentiate from cystic adenocarcinoma due to diffusely scattered multiple large cystic lesions in the liver, and it was histologically confirmed to have become malignant with cystic duct dilation after the operation. This case is reported herein with a literature review.

참고문헌 (Reference)

1 Cox H, "Well differentiated intrahepatic cholangiocarcinoma in the setting of biliary papillomatosis: a case report and review of the literature" 19 : 731-733, 2005

2 Li ZS, "The latest 2010 WHO classification of tumors of digestive system" 40 : 351-354, 2011

3 Vibert E, "Surgical strategy of biliary papillomatosis in Western countries" 17 : 241-245, 2010

4 Gunvén P, "Six-year recurrence free survival after intraluminal iridium-192 therapy of human bilobar biliary papillomatosis. a case report" 89 : 69-73, 2000

5 Sotiropoulos GC, "Papillomatosis confined to the distal biliary tract--a rare cause of obstructive jaundice: report of a case" 33 : 781-784, 2003

6 Vassiliou I, "Malignant potential of intrahepatic biliary papillomatosis: a case report and review of the literature" 4 : 71-, 2006

7 Meng WC, "Laser therapy for multiple biliary papillomatosis via choledochoscopy" 67 : 664-666, 1997

8 Terada T, "Intrahepatic biliary papillomatosis arising in nonobstructive intrahepatic biliary dilatations confined to the hepatic left lobe" 86 : 1523-1526, 1991

9 Aoki S, "Intrahepatic biliary papilloma morphologically similar to biliary cystadenoma" 20 : 321-324, 2005

10 Amaya S, "Expression of MUC1 and MUC2 and carbohydrate antigen Tn change during malignant transformation of biliary papillomatosis" 38 : 550-560, 2001

11 Giovannini M, "Endoscopic ultrasonography with a linear-type echoendoscope in the evaluation of 94 patients with pancreatobiliary disease" 26 : 579-585, 1994

12 Lai R, "EUS in multiple biliary papillomatosis" 55 : 121-125, 2002

13 Pojchamarnwiputh S, "Computed tomography of biliary cystadenoma and biliary cystadenocarcinoma" 49 : 392-396, 2008

14 Lee SS, "Clinicopathologic review of 58 patients with biliary papillomatosis" 100 : 783-793, 2004

15 Ma KF, "Clinical and radiological features of biliary papillomatosis" 44 : 169-173, 2000

16 Yeung YP, "Biliary papillomatosis:report of seven cases and review of English literature" 10 : 390-395, 2003

17 Kim YS, "Biliary papillomatosis: clinical, cholangiographic and cholangioscopic findings" 30 : 763-767, 1998

18 Hoang TV, "Biliary papillomatosis: CT and MR findings" 22 : 671-672, 1998

19 Ohta H, "Biliary papillomatosis with the point mutation of K-ras gene arising in congenital choledochal cyst" 105 : 1209-1212, 1993

20 Lam CM, "Biliary papillomatosis" 83 : 1715-1716, 1996

21 Nakanuma Y, "Biliary papillary neoplasm of the liver" 17 : 851-861, 2002

22 Levy AD, "Benign tumors and tumorlike lesions of the gallbladder and extrahepatic bile ducts: radiologic pathologic correlation" 22 : 387-413, 2002