Papillomatosis of the extrahepatic bile ducts and gallbladder diagnosed by endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).

agnostic workup because of elevated serum liver enzyme levels (γ-glutamyltransferase 53.94 μkat/L, reference range 0.00–0.63). A transabdominal ultrasound revealed dilated extrahepatic bile ducts, and on endoscopic ultrasound (EUS) the common bile duct (CBD) was dilated with hyperechoic fociwith no acoustic shadowing within, and a 20-mm hyperechoic frond-like mass was noted within the infundibulum of gallbladder (●" Fig. 1). The CBD and gallbladder walls were thin with smooth outer margins. Endoscopic retrograde cholangiography (ERC) revealed a 15-mm long filling defect within the dilated CBD (●" Fig. 2). A biopsy sample taken from the CBD showed evidence of tubulopapillary adenomawith foci of well-differentiated adenocarcinoma. An abdominal computed tomography (CT) scan showed atypical, but noncontrast-enhancing, hyperdense structures within the gallbladder infundibulum,whichwere not suggestive of tumor (●" Fig. 3). The patient underwent open laparotomy, cholecystectomy, and extensive resection of the extrahepatic bile ducts with Roux-en-Y hepaticojejunostomy. The histological examination confirmed the diagnosis of papillomatosis of the extrahepatic bile ducts, with foci of high-grade dysplasia (●" Fig. 4) and secondary growth extending into the gallbladder along the cystic duct. Biliary papillomatosis (BP) is a rare disease characterized by the presence of numerous papillary adenomas within the intraand/or extrahepatic biliary tree, with or without mucin hypersecretion [1]. It is a premalignant condition, undergoing malignant transformation in 25–50% of cases [1]. The diagnosis is based on histological examination of specimens obtained during ERC, cholangioscopy, or surgery. Papillary carcinoma, whichmanifests as awelldefined, polypoid mass obstructing the lumen of a single extrahepatic bile duct and as a single filling defect on ERC, should be distinguished frommulticentric biliary papillomatosis. Papillomatosis of the extrahepatic bile ducts and gallbladder diagnosed by endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP)