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Aim: Biliary papillomatosis is a rare disease. The aim of this work was to describe the characteristic cholangiographic findings and to define the role of ERC in the diagnosis of biliary papillomatosis.
Patient and method: A 72 year-old man was referred for ERC with mild right upper abdominal tenderness, lost weight and intermittent fever. The patient was cholecystectomized. Laboratory studies showed elevated activities of serum alkaline phosphatase and gamma glutamil transpeptidase but the level of serum bilirubin was normal. Abdominal US did not show dilated extra- and intrahepatic bile ducts. Duodenoscopy revealed the surface nodularity of the papilla of Vater. ERC showed multiple, round-to-ovoid filling defects in the extra- and intrahepatic bile ducts and ragged irregularity of bile duct wall. EST was performed and biopsies were taken from the papilla of Vater and from the extrahepatic bile ducts via transpapillary route.
Result: Histological examination of biopsy specimens showed diffuse papillary-adenomatoid proliferation of bile duct epithelial cells. The final diagnosis was biliary papillomatosis. However this disorder is benign but has a great potential for malignant transformation and the negative histological result may not exclude the possibility that a malignant condition is present. Unfortunately, radical resection (Whipple procedure and partial hepatectomy) was not possible because of poor general condition of patient, who died of severe heart failure 3 months later.
Conclusion: ERC is essential for the diagnosis of biliary papillomatosis and for evaluation of the extent of the disease and provides the possibility for transpapillary biopsies.