Joint Hospital Surgical Grand Round . 18 th April 2009. Biliary Papillomatosis: unrecognised preoperative diagnosis. Law, SY F/ 68 HT & DM on medications Open cholecystectomy (symptomatic gallstone) for 10 years ago CBD stones with ERCP for removal in 2004. c/o mild RUQ pain in OPD FU
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18th April 2009
Biliary papillomatosis (BP) is a rare disease entity with malignant potential.
BP was considered in the past to be a disease with low malignant potential.
Biliary papillomatosis (BP) is defined as papillary proliferation of the lining epithelium of the bile duct tree, further classified into 5 classes according to the degree cytological and structural atypia
is defined as BP with low-grade atypia proliferation of the lining epithelium of the bile duct tree, further classified into 5 classes according to the degree cytological and structural atypia
as BP with high-grade atypia
as BP with in situ carcinoma
as BP with microscopic foci of stromal invasion
BP with definite invasion into the hepatic parenchyma or fibromuscular layer of the bile duct wall
might be similar to bile duct stones.
cystadenoma, cystadenicarcinoma and liver abscess.
malignant transformation may not be properly excluded in the ‘benign’ cases reported in the literature.
prolonged follow-up may allow detection of malignant transformation. Progression from epithelial dysplasia to carcinoma in situ and to frank invasive adenocarcinoma has been suggested
chronic biliary irritation or injury may play a contributory role.
The End clinical behaviour, the high recurrence rate and the even higher malignant transformation occurrence, as well as the presence of carcinogenetic indicators (K-ras mutation, overexpression of p53, MUC, and Tn antigens) strongly support that BP is a low-grade neoplasm with high malignant potential.