Multiple biliary papillomatosis

Abstract

A case of multiple biliary papillomata with nuclear atypical changes involving the entire biliary ductal system is presented. Initially the tumor was resected in the common bile duct. The only remaining tumor appeared to be in the left hepatic ductal system on cholangiogram. The patient then underwent left hepatic lobectomy. The tumor recurred, however, throughout the right hepatic ductal system as demonstrated on cholangiograms. Curettage was employed to remove tumor bulk, and drainage was accomplished with a choledochoduo-denostomy. The patient subsequently had several attacks of cholangitis with obstruction secondary to tumor involvement of the common bile duct, demonstrated on upper gastrointestinal series, and again was relieved for a period of time by curettage. The patient was finally treated with BCNU and a decrease in the tumor mass was noted. He progressed and eventually died with gram negative shock secondary to cholangitis.