Biliary papillomatosis in the common bile duct.

A 62-year-oldwomanwas admitted to our hospital with abdominal pain. Clinical examination revealed definite tenderness in the right hypochondrium only. Laboratory assessment on admission was normal. An abdominal ultrasound was performed, which showed an irregular hyperechoic pseudomass of the gallbladder. An abdominal contrast-enhanced computed tomography (CT) scan (●" Fig.1) and a magnetic resonance imaging (MRI) scan of the liver (●" Fig.2) revealed thepresence of an abnormal tissue mass at the hilum of the liver. The suspected diagnosis was confirmed by biliopancreatic endoscopic ultrasound (EUS),which showedanabnormal piece of tissue floating at the upper pole of the common bile duct (●" Fig.3). The tissue was not invading the common bile duct wall and the endoluminal choledochal surface was intact. These results suggested a benign endoluminal lesion so no biopsywas performed. The case was discussed by the multidisciplinary oncological team who decided that surgery should be performed. The resected tissue included the gallbladder, extrahepatic bile ducts, and hilar and retropancreatic lymph nodes (●" Fig.4). A hepaticojejunal anastomosis (Roux-en-Y) was created. The postoperative period was uncomplicated. At microscopic examination, the intraductal region of papillomatosis was found to be surrounded by an invasive tumor, a typical well-differenFig.1 Computed tomography (CT) scan of a 62-year-old woman with abdominal pain and an irregular hyperechoic pseudomass of the gallbladder on ultrasound showing an abnormal tissue mass at the hilum of the liver (1, common bile duct; 2, tumor mass).