Diagnosis

Benign bile duct tumor

Tumors < 2 cm in size that arise from ductal glandular epithelium most commonly found at the ampulla of Vater.

Also known as: Benign cholangioma, Bile duct adenoma

Etiology

Cause

Reactive
Traumatic
Malformative proliferation: adenoma/adenofibroma/hamartoma

Pathophysiology

Benign bile duct tumor --> bile duct obstruction --> hepatocellular dysfunction (coagulopathy, pruritus, renal dysfunction, cholangitis)

Epidemiology

Incidence per 100.000 [gtd][hyk][sc6]

Epidemiology chart for Incidence

Symptoms & findings

Symptoms

Clinical findings

Cholestasis, Elevated ALP, Elevated Bilirubin, Elevated GGT, Jaundice

Anamneses

None listed.

Localized findings

Pain

Radiates

RUQ (Right Upper Quadrant)

Onset

Gradual (days)

Pattern

Constant

Severity

Mild (1-3)

Approach

Blood test
Intraoperative cholangiogram
Ultrasound abdomen
MRCP
ERCP
PTC

Treatment

No treatment unless symptoms (obstruction) or cancer
Obstruction:
- Stent
- Endoscopic mucosal resection
- Transduodenal papillotomy
- Surgery with intraoperative frozen section
  - Bile duct resection [small tumors)
  - Whipple operation
  - Hepatic lobectomy
  - Liver transplantation

Differential diagnoses

Bile duct stricture, Biliary obstruction, Carcinoma of the ampulla of Vater, Cholangiocarcinoma, Cholangitis, Cholecystitis, Choledocholithiasis, Cholelithiasis, Gallbladder cancer, Gastrinoma, Glucagonoma, Hepatocellular carcinoma, Insulinoma, Liver abscess, Pancreatic cancer, Primary biliary cirrhosis, Primary sclerosing cholangitis, VIPoma

References

[1] Čekas et al. Common bile duct villous adenoma: a case report and review of the literature. J Med Case Reports 10, 18 (2016).

[2] Sarcognato et al. Benign biliary neoplasms and biliary tumor precursors. Pathologica. 2021 Jun;113(3):147-157.

[3] Aishima et al. (2014), Bile duct adenoma in liver disease. Pathol Int, 64: 551-559.

[4] [First Aid for the Surgery Clerkship]