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Benign tumours of the biliary tract



Neoplasia of the biliary tract is uncommon. Carcinoma of the gallbladder and bile duct appear infrequently, and benign tumours are decidedly rare.

 

Polyps in the gallbladder are sometimes seen on ultrasound or on a cholecystogram. The majority of these are cholesterol polyps or adenomyomas and are not, therefore, true tumours. If gallstones are also present and causing symptoms then the patient needs a cholecystectomy. If they are an isolated finding most surgeons believe that they sometimes cause symptoms; provided these are sufficiently severe surgery is justified. If surgery is not appropriate and the polyps are large they should be monitored radiologically, and removal is advised if they enlarge.

 

True adenomas do occur and they have a malignant potential. This is most likely to occur if they are larger than 10 mm in diameter and sessile. Such patients require cholecystectomy.

 

Papillomas of the bile duct occur most commonly at the ampulla and are usually small. They present with biliary tract obstruction or recurrent pancreatitis. ERCP reveals the lesion unfolding into the duodenum as the sphincterotomy is made. These lesions are usually regarded as premalignant, and they should be removed either surgically or endoscopically. Papillomas are sometimes multiple and when crowded together look like a villous adenoma (Fig. 51) 1274. These lesions tend to recur and to become malignant. It is obviously important to remove them; depending on their site in the biliary tract and their extent, this may require an hepatic resection.

 

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