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  • Gallbladder adenoma

    • -Rare

      -Considered premalignant lesion

      -Minimal to no risk if < 1 cm

    Papillomatosis: Multiple gallbladder adenomas

    Adenomyomatosis: Gallbladder wall hyperplasia that can be diffuse, possibly premalignant

    • Leiomyomas, lipomas, hemangiomas, and heterotopic GI tissue are all other possible benign biliary neoplasms

    • Approximately 67% of benign biliary neoplasms are polyps, adenomatous papillomas, or bile duct adenomas; not known to have malignant potential

    • 47% of benign biliary neoplasms found in periampullary region and 27% found in common bile duct

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Epidemiology

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  • • 5% incidence of gallbladder polyps of which 50% are cholesterol polyps

    • < 1% incidence of benign biliary tumors

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Symptoms and Signs

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  • • Asymptomatic

    • Biliary colic or cholecystitis

    • Jaundice

    • Anorexia

    • Fever

    • Nausea

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Laboratory Findings

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  • • Leukocytosis if cholecystitis or cholangitis is present

    • Hyperbilirubinemia

    • Elevated alkaline phosphatase level

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Imaging Findings

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  • • Right upper quadrant US

    • -Shows thickened gallbladder wall for adenomyomatosis

      -Shows submuscular hyperechoic areas in cholesterol polyps

      -Shows hyperechoic polypoid structures without shadowing for gallbladder adenomas

      -Shows biliary dilatation and possible stricture for benign biliary neoplasms

    • ERCP and percutaneous transhepatic cholangiogram (PTC) reveal stricture and proximal biliary dilatation, suggesting benign biliary neoplasms

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Rule Out

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  • • Possible malignancy making resection often necessary to verify diagnosis

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  • • History and physical exam

    • CBC

    • Liver function tests

    • Carcinoembryonic antigen (CEA) and CA 19-9

    • Right upper quadrant US

    • PTC or ERCP

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Surgery

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  • • Cholecystectomy for gallbladder adenomatous polyps > 1 cm

    • Resection of biliary stricture and bilio-enteric reconstruction for benign biliary neoplasms causing jaundice or cholangitis

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Complications

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  • • Biliary leak or stricture

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References

Baillie J: Tumors of the gallbladder and bile ducts. J Clin Gastroenterol 1999;29:14.  [PubMed: 10405225]
Bismuth H, Majno PE: Hepatobiliary surgery. J Hepatol 2000;32(1 Suppl):208.

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