Biliary Neoplasms, Benign

• • 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

Epidemiology

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

  • < 1% incidence of benign biliary tumors

Symptoms and Signs

• • Asymptomatic

  • Biliary colic or cholecystitis

  • Jaundice

  • Anorexia

  • Fever

  • Nausea

Laboratory Findings

• • Leukocytosis if cholecystitis or cholangitis is present

  • Hyperbilirubinemia

  • Elevated alkaline phosphatase level

Imaging Findings

• • 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

Rule Out

• • Possible malignancy making resection often necessary to verify diagnosis

• • History and physical exam

  • CBC

  • Liver function tests

  • Carcinoembryonic antigen (CEA) and CA 19-9

  • Right upper quadrant US

  • PTC or ERCP

Surgery

• • Cholecystectomy for gallbladder adenomatous polyps > 1 cm

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

Complications

• • Biliary leak or stricture

References