Korean J Gastroenterol.  2015 Jul;66(1):55-58. 10.4166/kjg.2015.66.1.55.

Volume-reserving Surgery after Photodynamic Therapy for Biliary Papillomatosis: A Case Report

• Cheong CO
• Lim JH
• Park JS
• Park SW
• Kim HK
• Kim KS

• KMID: 2373313
• DOI: http://doi.org/10.4166/kjg.2015.66.1.55

Abstract

Biliary papillomatosis is rare, and its pathogenic mechanisms are not yet clear. Because of its high risk for malignancy transformation, surgical resection is regarded as a standard treatment. Photodynamic therapy (PDT) has been used by the intravenous administration of hematoporphyrin derivative followed by laser exposure. A photochemical process causes disturbance of the microvascular structure and degradation of membrane. Cholangitis is a major complication after PDT. A healthy 56-year-old man was diagnosed with biliary papillomatosis involving the common hepatic duct, both proximal intrahepatic bile ducts (IHD), and the right posterior IHD. After biliary decompression by endoscopic nasobiliary drainage, PDT was performed to avoid extensive liver resection and recurrence using endoscopic retrograde cholangiographic guidance. After portal vein embolization, the patient underwent extended right hemihepatectomy. Following administration of chemoradiation therapy with tegafur-uracil and 45 Gy due to local recurrence at postoperative 13 months, there was no local recurrence or distant metastases. This is the first case report on PDT for biliary papillomatosis in Korea. Preoperative PDT is beneficial for reducing the lesion in diffuse or multifocal biliary papillomatosis and may lead to curative and volume reserving surgery. Thus, PDT could improve the quality of life and prolong life expectation for biliary papillomatosis patients.

Keyword

Papilloma, intraducal; Hepatectomy; Photochemotherapy

MeSH Terms

Antineoplastic Agents/therapeutic use
Bile Duct Neoplasms/*diagnosis/drug therapy/surgery
Bile Ducts, Intrahepatic/pathology
Embolization, Therapeutic
Gamma Rays
Hepatectomy
Hepatic Duct, Common/pathology
Humans
Male
Middle Aged
Neoplasm Recurrence, Local
Papilloma/*diagnosis/drug therapy/surgery
Photochemotherapy
Tegafur/therapeutic use
Uracil/therapeutic use
Antineoplastic Agents
Tegafur
Uracil

Figure

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  Fig. 1. (A) Two-dimensional thick-section rapid acquisition with relaxation enhancementimage shows an irregular intraluminal filling defect in the common bile duct and left intrahepatic duct (arrows). Both intrahepatic ducts are dilated. (B) Papillary atypical epithelial proliferation in the left intrahepatic duct 1st portion before photodynamic therapy (H&E stain, ×100).

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  Fig. 2. (A, B) Percutaneous transhepatic cholangioscopy before photodynamic therapy (PDT) shows diffuse biliary papillomatosis from the distal common bile duct to the left intrahepatic duct 2nd portion. (C) Damaged epithelial cells and scars after PDT, and there is no evidence of remnant papillomatosis. (D) Pathologic specimen from right extended hepatectomy.

Reference

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