Forlano Immacolata, Fersini Alberto, Tartaglia Nicola, Ambrosi Antonio, Neri Vincenzo
Department of Surgical Sciences, Division of General Surgery, University of Foggia, Polyclinic Ospedali Riuniti Foggia, Italy.
Ann Ital Chir. 2011 Sep-Oct;82(5):405-8.
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.
胆管乳头状瘤病是一种以肝内和/或肝外胆管树中分布和范围各异的多个乳头状肿瘤为特征的疾病。这些病变内可发生乳头状癌。由于胆管乳头状瘤病是一种罕见的胆管病理实体，其临床特征和预后尚不清楚。这种疾病的病程非常漫长。这种诊断困难主要是由于胆管乳头状瘤病与胆石症之间难以区分。治疗策略应在术前在切除、移植或支架置入之间做出决定。在许多情况下，手术策略是在手术过程中根据肿块的扩展、局部浸润和患者年龄来决定的，并且在可能的情况下，借助术中组织学检查来决定。最近，我们遇到一例82岁男性肝总管胆管乳头状瘤病患者，表现为梗阻性黄疸、右上腹和上腹部疼痛并放射至同侧肩胛骨。我们首先进行了胆囊切除术并放置了T管。通过实验室检查和T管胆管造影进行的随访显示无黄疸，但胆总管内的充盈缺损仍然存在。于是我们进行了胆总管切除术并在肝蒂处进行了肝空肠吻合术。组织学检查显示胆总管绒毛状腺瘤伴高级别异型增生。
