Double Intrahepatic and Extrahepatic Cholangiocarcinomas Arising from Biliary Papillomatosis: A Case Report

  • Kim, Say-June (Department of Surgery, Deajeon St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Jung-Uee (Department of Pathology, Deajeon St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • 발행 : 2010.03.30

초록

Biliary papillomatosis is a rare disease entity characterized by multiple papillary adenomas along the bile duct mucosa. It is widely accepted that the adenoma-carcinoma sequence represents the process by which most, if not all, cholangiocarcinomas of an intraductal-growing type arise. Interestingly, friable papillary projections easily detached from the primary site can be implanted into the other sites in the bile duct in suitable animal models, resulting in multiple tumors. A 76-year-old male was referred to our hospital due to intermittent abdominal discomfort. Imaging workups revealed two lesions: wall thickening in the proximal portion of the left interhepatic duct and abrupt narrowing of the distal common bile duct. A hepatopancreaticoduodenectomy was carried out and pathological analysis demonstrated a well-differentiated adenocarcinoma of the left hepatic duct and carcinoma in situ of the distal common bile duct on a background of biliary papillomatosis. Six days after the operation, the patient received a re-exploration due to ruptured mesenteric vessels. Unfortunately, 3 months after the initial operation, the patient died of aspiration pneumonia. Biliary papillomatosis can present with a broad spectrum of disease characteristics ranging from adenoma to, usually, low-grade adenocarcinoma. If there is a complete excision, and a favorable postoperative course is secured, excellent survival can be expected after surgery.

키워드

참고문헌

  1. Taguchi J, Yasunaga M, Kojiro M, Arita T, Nakayama T, Simokobe T. Intrahepatic and extrahepatic biliary papillomatosis. Arch Pathol Lab Med 1993;117:944-947.
  2. Yeung YP, AhChong K, Chung CK, Chun AY. Biliary papillomatosis: report of seven cases and review of English literature. J Hepatobiliary Pancreat Surg 2003;10:390-395. https://doi.org/10.1007/s00534-002-0837-0
  3. Lee SS, Kim MH, Lee SK, et al. Clinicopathologic review of 58 patients with biliary papillomatosis. Cancer 2004;100:783- 793. https://doi.org/10.1002/cncr.20031
  4. The general rules for the clinical and pathological study of primary liver cancer. Liver Cancer Study Group of Japan. Jpn J Surg 1989;19:98-129. https://doi.org/10.1007/BF02471576
  5. Okulski EG, Dolin BJ, Kandawalla NM. Intrahepatic biliary papillomatosis. Arch Pathol Lab Med 1979;103:647-649.
  6. Nakanuma Y, Sasaki M, Ishikawa A, Tsui W, Chen TC, Huang SF. Biliary papillary neoplasm of the liver. Histol Histopathol 2002;17:851-861.
  7. Kim YI, Yu ES, Kim ST. Intraductal variant of peripheral cholangiocarcinoma of the liver with Clonorchis sinensis infection. Cancer 1989;63:1562-1566. https://doi.org/10.1002/1097-0142(19890415)63:8<1562::AID-CNCR2820630819>3.0.CO;2-8
  8. Suh KS, Roh HR, Koh YT, Lee KU, Park YH, Kim SW. Clinicopathologic features of the intraductal growth type of peripheral cholangiocarcinoma. Hepatology 2000;31:12-17. https://doi.org/10.1002/hep.510310104
  9. Ma KF, Iu PP, Chau LF, Chong AK, Lam HS. Clinical and radiological features of biliary papillomatosis. Australas Radiol 2000;44:169-173. https://doi.org/10.1046/j.1440-1673.2000.00803.x
  10. Chung DJ, Lee SK, Ha HK, Kim PN, Lee MG. Multiple biliary papillomatosis: comparison of MR cholangiography with endoscopic retrograde cholangiography. J Comput Assist Tomogr 2002;26:968-974. https://doi.org/10.1097/00004728-200211000-00020
  11. Kim HJ, Kim MH, Lee SK, et al. Mucin-hypersecreting bile duct tumor characterized by a striking homology with an intraductal papillary mucinous tumor (IPMT) of the pancreas. Endoscopy 2000;32:389-393. https://doi.org/10.1055/s-2000-8996
  12. Chen MF, Jan YY, Chen TC. Clinical studies of mucin- producing cholangiocellular carcinoma: a study of 22 histopathology- proven cases. Ann Surg 1998;227:63-69. https://doi.org/10.1097/00000658-199801000-00010
  13. Shimonishi T, Zen Y, Chen TC, et al. Increasing expression of gastrointestinal phenotypes and p53 along with histologic progression of intraductal papillary neoplasia of the liver. Hum Pathol 2002;33:503-511. https://doi.org/10.1053/hupa.2002.124030
  14. Chen TC, Nakanuma Y, Zen Y, et al. Intraductal papillary neoplasia of the liver associated with hepatolithiasis. Hepatology 2001;34:651-658.
  15. Lim JH, Park CK. Pathology of cholangiocarcinoma. Abdom Imaging 2004;29:540-547.
  16. Sasaki A, Aramaki M, Kawano K, et al. Intrahepatic peripheral cholangiocarcinoma: mode of spread and choice of surgical treatment. Br J Surg 1998;85:1206-1209. https://doi.org/10.1046/j.1365-2168.1998.00815.x
  17. Choi BI, Lee JH, Han MC, Kim SH, Yi JG, Kim CW. Hilar cholangiocarcinoma: comparative study with sonography and CT. Radiology 1989;172:689-692. https://doi.org/10.1148/radiology.172.3.2549565
  18. Gulluoglu MG, Ozden I, Poyanli A, Cevikbas U, Ariogul O. Intraductal growth-type mucin-producing peripheral cholangiocarcinoma associated with biliary papillomatosis. Ann Diagn Pathol 2007;11:34-38. https://doi.org/10.1016/j.anndiagpath.2006.09.003
  19. Lim JH. Cholangiocarcinoma: morphologic classification according to growth pattern and imaging findings. AJR Am J Roentgenol 2003;181:819-827. https://doi.org/10.2214/ajr.181.3.1810819
  20. Dumortier J, Scoazec JY, Valette PJ, Ponchon T, Boillot O. Successful liver transplantation for diffuse biliary papillomatosis. J Hepatol 2001;35:542-543. https://doi.org/10.1016/S0168-8278(01)00126-X
  21. Beavers KL, Fried MW, Johnson MW, et al. Orthotopic liver transplantation for biliary papillomatosis. Liver Transpl 2001; 7:264-266. https://doi.org/10.1053/jlts.2001.22322