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Yusif-Zade K, Musayev J, Yeler M. Tubulopapillary adenoma of the common bile duct presenting with jaundice. ULUSAL CERRAHI DERGISI 2016; 32:226-8. [PMID: 27528819 DOI: 10.5152/ucd.2015.2953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/26/2014] [Indexed: 11/22/2022]
Abstract
In this report, an adult patient with tubulopapillary adenoma of the common bile duct that manifested with jaundice is presented. Diagnostic challenges were analyzed. Although adenomas of the common bile duct are rare, they should be kept in mind in the differentiation of lesions of this region. It should be remembered that these lesions radiologically could mimic carcinoma and choledocholithiasis. Endoscopic resection should be considered as the primary method for treatment. Histopathology is the gold standard in diagnosis.
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Affiliation(s)
- Kenan Yusif-Zade
- Department of 3 Surgical Diseases, Azerbaijan Medical University, Baku, Azerbaijan
| | - Jamal Musayev
- Department of Pathology, Azerbaijan Medical University, Baku, Azerbaijan
| | - Maryam Yeler
- Department of Endoscopy, Private "HB Güven Clinic" Baku, Azerbaijan
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Rafiq E, Alaradi O, Bawany M, Nawras A. A combination of snare polypectomy and apc therapy for prolapsing common bile duct adenoma. JOURNAL OF INTERVENTIONAL GASTROENTEROLOGY 2012; 2:193-195. [PMID: 23687608 DOI: 10.4161/jig.23743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/05/2012] [Accepted: 08/08/2012] [Indexed: 01/08/2023]
Affiliation(s)
- Ehsan Rafiq
- Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
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Kim BS, Joo SH, Joo KR. Carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct: A case report. World J Gastroenterol 2008; 14:4705-8. [PMID: 18698689 PMCID: PMC2738799 DOI: 10.3748/wjg.14.4705] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Tubulovillous adenomas are common in the colon and rectum, but are rare in the common bile duct. Biliary adenomas may produce obstructive jaundice, which can be easily confused with a malignant neoplasm or stone. We report a case of a carcinoma in situ arising in a tubulovillous adenoma of the distal common bile duct causing obstructive jaundice. A 55-year-old male presented with a 10-d history of pruritus and progressive jaundice. Abdominal sonography and computed tomography showed a mass in the distal common bile duct. Endoscopic retrograde cholangiopancreatography showed luminal narrowing of the bile duct due to a polypoid mass. Positron emission tomography demonstrated no abnormal uptake. It was thought that this mass was a malignant tumor, thus a pylorus-preserving panceaticoduodenectomy was performed. The final pathology showed a tubulovillous adenoma with carcinoma in situ of the distal common bile duct. At follow-up 8 mo later, endoscopy showed multiple polyps in the rectum, colon and stomach. The polyps were removed by endoscopic mucosal resection and shown to be tubular adenomas with high grade dysplasia. Biliary adenomas require careful follow-up for early detection of recurrence and malignant transformation.
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Buc E, Lesurtel M, Belghiti J. Is preoperative histological diagnosis necessary before referral to major surgery for cholangiocarcinoma? HPB (Oxford) 2008; 10:98-105. [PMID: 18773064 PMCID: PMC2504385 DOI: 10.1080/13651820802014585] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Indexed: 12/12/2022]
Abstract
Major surgical resection is often the only curative treatment for cholangiocarcinoma. When imaging techniques fail to establish the accurate diagnosis, biopsy of the lesion is unavoidable. However, biopsy is not necessarily required for topography of the cholangiocarcinoma (intrahepatic or extrahepatic). 1) In extrahepatic cholangiocarcinoma (ECC), clinical features and radiological imaging relate to biliary obstruction. Provided that between 8% and 43% of bile duct strictures are not ECC, the lesions mimicking ECC that should be ruled out are gallbladder cancer, Mirizzi syndrome, primary sclerosing cholangitis (PSC), autoimmune pancreatitis and portal biliopathy. Systematic biopsy is usually difficult and has poor sensitivity, but a good knowledge of these mimicking ECC diseases, along with precise analysis of clinical and imaging semiology, may lead to a correct diagnosis without the need for biopsy. 2) Intrahepatic cholangiocarcinoma (ICC) developing in normal liver appears as a hypovascular tumour with fibrotic component and capsular retraction that can be confused with fibrous metastases such as breast and colorectal cancers. The lack of the primary site, a relatively large tumour size and ancillary findings such as bile duct dilatation may provide a clue to the diagnosis. If not, we advocate local resection with lymph node dissection, since ICC is the most likely diagnosis and surgery is the only curative treatment. In the event of adenocarcinoma from unknown primary, surgery is an effective treatment even if prognosis is poor.
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Affiliation(s)
- E. Buc
- Department of HBP Surgery, Hospital BeaujonClichyFrance
| | - M. Lesurtel
- Department of HBP Surgery, Hospital BeaujonClichyFrance
| | - J. Belghiti
- Department of HBP Surgery, Hospital BeaujonClichyFrance
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Katsinelos P, Basdanis G, Chatzimavroudis G, Karagiannoulou G, Katsinelos T, Paroutoglou G, Papaziogas B, Paraskevas G. Pancreatitis complicating mucin-hypersecreting common bile duct adenoma. World J Gastroenterol 2006; 12:4927-9. [PMID: 16937485 PMCID: PMC4087637 DOI: 10.3748/wjg.v12.i30.4927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Villous adenomas of the bile ducts are extremely uncommon. We describe a 58-year-old man presenting with clinical signs and laboratory findings of acute pancreatitis and obstructive jaundice. Preoperative investigation demonstrated a dilated papillary orifice with mucus exiting (fish-mouth sign) and a filling defect in the distal common bile duct. He underwent a modified Whipple operation and histological examination of the surgical specimen showed villous adenoma with rich secretion of mucus.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, G.Gennimatas Hospital, Ethnikis Aminis 41, Thessaloniki 54635, Greece.
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Jung AY, Lee JM, Choi SH, Kim SH, Lee JY, Kim SW, Han JK, Choi BI. CT features of an intraductal polypoid mass: Differentiation between hepatocellular carcinoma with bile duct tumor invasion and intraductal papillary cholangiocarcinoma. J Comput Assist Tomogr 2006; 30:173-81. [PMID: 16628028 DOI: 10.1097/00004728-200603000-00002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the CT features capable of differentiating hepatocellular carcinoma (HCC) with bile duct tumor invasion (BDTI) from intraductal cholangiocarcinoma (IDCC). METHODS Multiphasic CT images of 14 patients with HCC with BDTI and 18 patients with IDCC were retrospectively reviewed. Analysis of the CT findings included the size, location, and margin of the intraductal mass, the enhancement pattern of intraductal lesions, degree of ductal dilatation, presence of downstream ductal dilatation and ductal wall thickening, presence of parenchymal mass and its size, continuity of parenchymal mass with intraductal mass, and liver cirrhosis. Objective evaluation of the enhancement patterns of intraductal tumors was done by measuring the CT attenuation coefficients of the tumors and the uninvolved hepatic parenchyma in each phase. Among these findings, statistically significant variables were then determined using Fisher exact test or Mann-Whitney test. RESULTS Significant variables that helped differentiating HCC with BDTI from IDCC included the presence of parenchymal mass, liver cirrhosis, and the hyperattenuating intraductal tumor on the hepatic arterial phase (HAP). On unenhanced images, the tumor-to-liver contrast of IDCC (16.7 +/- 8.1) was greater than that of HCC with BDTI (6.4 +/- 10.4), but on HAP, that of HCC with BDTI (26.5 +/- 28.2) was greater than that of IDCC (5.9 +/- 18.7) (P < 0.05). In addition, there was a significant difference in the enhancement ratio of the intraductal tumors on portal venous phase (PVP) between the 2 conditions (P = 0.003). CONCLUSIONS Several objective and subjective multiphasic CT findings may help differentiating HCC with BDTI from IDCC.
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Affiliation(s)
- Ah Young Jung
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Jung AY, Lee JM, Choi SH, Kim SH, Lee JY, Kim SW, Han JK, Choi BI. Computed tomography features of an intraductal polypoid mass: differentiation between hepatocellular carcinoma with bile duct tumor invasion and intraductal papillary cholangiocarcinoma. J Comput Assist Tomogr 2006; 30:18-24. [PMID: 16365567 DOI: 10.1097/01.rct.0000188837.71136.fe] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the computed tomography (CT) features capable of differentiating hepatocellular carcinoma (HCC) with bile duct tumor invasion (BDTI) from intraductal cholangiocarcinoma (IDCC). METHODS Multiphasic CT images of 14 patients with HCC with BDTI and 18 patients with IDCC were retrospectively reviewed. Analysis of the CT findings included the size, location, and margin of the intraductal mass; enhancement pattern of intraductal lesions; degree of ductal dilatation; presence of downstream ductal dilatation and ductal wall thickening; presence of a parenchymal mass and its size; continuity of the parenchymal mass with the intraductal mass; and liver cirrhosis. Objective evaluation of the enhancement patterns of intraductal tumors was done by measuring the CT attenuation coefficients of the tumors and the uninvolved hepatic parenchyma in each phase. Among these findings, statistically significant variables were then determined using the Fisher's exact test or Mann-Whitney U test. RESULTS Significant variables that helped to differentiate HCC with BDTI from IDCC included the presence of a parenchymal mass, liver cirrhosis, and a hyperattenuating intraductal tumor on the hepatic arterial phase (HAP). On unenhanced images, the tumor-to-liver contrast of IDCC (16.7+/-8.1) was greater than that of HCC with BDTI (6.4+/-10.4), but on the HAP, that of HCC with BDTI (26.5+/-28.2) was greater than that of IDCC (5.9+/-18.7) (P<0.05). In addition, there was a significant difference in the enhancement ratio of the intraductal tumors on the portal venous phase between the 2 conditions (P=0.003). CONCLUSIONS Several objective and subjective multiphasic CT findings may help to differentiate HCC with BDTI from IDCC.
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Affiliation(s)
- Ah Young Jung
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Fletcher ND, Wise PE, Sharp KW. Common Bile Duct Papillary Adenoma Causing Obstructive Jaundice: Case Report and Review of the Literature. Am Surg 2004. [DOI: 10.1177/000313480407000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Common bile duct (CBD) adenomas are rare tumors that often present in a fashion similar to their malignant counterparts. We report a case of a papillary CBD adenoma causing obstructive jaundice. We also present a review of the CBD adenomas found in the English literature through a Medline search (1970–2003). A 74-year-old female presented with a 10-day history of pruritus, progressive painless jaundice, acholic stools, bilirubinuria, and 10-lb weight loss. Abdominal exam showed no masses. Abdominal ultrasound (U/S) showed cholelithiasis without choledocholithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic U/S revealed a shelf-like stricture, 1.5 cm long and 0.9 cm in diameter, located in the distal CBD. At the time of biliary stent placement, fine-needle aspiration showed benign ductal epithelial cells in sheets and clusters. Abdominal CT scan showed a low attenuation 15 x 17 mm lesion in the head of the pancreas that abutted the superior mesenteric vein (SMV) but no metastatic lesions. We performed a standard pancreaticoduodenectomy (Whipple procedure). Final pathology showed a papillary adenoma without evidence of dysplasia in the distal common bile duct proximal to the ampulla of Vater. The incidence of these tumors and their potential for malignant degeneration is unknown. Pancreaticoduodenectomy is an effective means of treatment and cure for CBD adenoma.
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Affiliation(s)
- Nicholas D. Fletcher
- From the Department of Surgery, Division of General Surgery, Vanderbilt University Medical Center Nashville, Tennessee
| | - Paul E. Wise
- From the Department of Surgery, Division of General Surgery, Vanderbilt University Medical Center Nashville, Tennessee
| | - Kenneth W. Sharp
- From the Department of Surgery, Division of General Surgery, Vanderbilt University Medical Center Nashville, Tennessee
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Akin O, Coskun M. Biliary adenofibroma with malignant transformation and pulmonary metastases: CT findings. AJR Am J Roentgenol 2002; 179:280-1. [PMID: 12076957 DOI: 10.2214/ajr.179.1.1790280] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Oguz Akin
- School of Medicine, Baskent University, 06490 Ankara, Turkey
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Ma KF, Iu PP, Chau LF, Chong AK, Lam HS. Clinical and radiological features of biliary papillomatosis. AUSTRALASIAN RADIOLOGY 2000; 44:169-73. [PMID: 10849979 DOI: 10.1046/j.1440-1673.2000.00803.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Biliary papillomatosis is a rare disease with strong potential for malignant degeneration. Diagnosis is often not easy and most are made intraoperatively. In the present study, five patients with biliary papillomatosis admitted between 1990 and 1997 were reviewed. Their clinical presentation, radiological and biochemical findings were analysed. The aim of the study was to discern a set of characteristic features that would enable an early diagnosis. All of the five patients presented with recurrent episodes of acute cholangitis and epigastric pain with raised serum alkaline phosphatase. Imaging modalities including ultrasound, CT, endoscopic retrograde cholangio-pancreatogram, MRI and magnetic resonance cholangio-pancreatogram were reviewed. Salient imaging features included a dilated biliary tree with multiple ill-defined and fuzzy filling defects or endoluminal frond-like mass lesions. In conclusion, biliary papillomatosis is a rare but important cause of biliary obstruction with relapsing cholangitis and obstructive jaundice. With a healthy index of suspicion, the diagnosis can be reached when the above features are available.
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Affiliation(s)
- K F Ma
- Department of Diagnostic Radiology, Kwong Wah Hospital, Kowloon, Hong Kong.
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Blot E, Heron F, Cardot F, Kerleau JM, Metayer J, Michot F, Bourreille J. Villous adenoma of the common bile duct. J Clin Gastroenterol 1996; 22:77-9. [PMID: 8776106 DOI: 10.1097/00004836-199601000-00024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- E Blot
- Clinique Médicale, CHU de Rouen, France
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Abstract
Jaundice is usually a late feature in the course of hepatocellular carcinoma and is only rarely due to obstruction. We present two cases of obstructive jaundice, in which the cause of obstruction in both patients was a massive intraluminal filling defect within the common bile duct which proved to be hepatocellular carcinoma. The radiological features are described.
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Affiliation(s)
- J M Kirk
- Department of Diagnostic Radiology, St George's Hospital, London
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