Papillary carcinoma with diffuse papillomatosis of gallbladder and cystic duct

• Published in: Annals of diagnostic pathology Vol. 15; no. 2; pp. 140 - 144
• Main Authors: Kosemehmetoglu, Kemal, MD, Akpinar, Erhan, MD, Sokmensuer, Cenk, MD, Hamaloglu, Erhan, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2011
• Subjects: Bile Ducts - metabolism; Bile Ducts - pathology; Bile Ducts - surgery; Biliary Tract Neoplasms - metabolism; Biliary Tract Neoplasms - pathology; Biliary Tract Neoplasms - surgery; Carcinoma, Papillary - metabolism; Carcinoma, Papillary - pathology; Carcinoma, Papillary - surgery; Cell Transformation, Neoplastic; Cyclin-Dependent Kinase Inhibitor p21 - metabolism; Cystic Duct - metabolism; Cystic Duct - pathology; Cystic Duct - surgery; Diagnosis, Differential; Female; Follow-Up Studies; Gallbladder; Gallbladder - metabolism; Gallbladder - pathology; Gallbladder - surgery; Hepatic Duct, Common - metabolism; Hepatic Duct, Common - pathology; Hepatic Duct, Common - surgery; Humans; Immunohistochemistry; Ki-67 Antigen - metabolism; Ki67; MDM2; Middle Aged; p21; p53; Pancreaticoduodenectomy; Papillary carcinoma; Papilloma - metabolism; Papilloma - pathology; Papilloma - surgery; Papillomatosis; Pathology; Proto-Oncogene Proteins c-mdm2 - metabolism; Tomography, X-Ray Computed; Treatment Outcome; Tumor Suppressor Protein p53 - metabolism; Papillomatosis; Papillary carcinoma; MDM2; Gallbladder; Ki67; p21; p53
• ISSN: 1092-9134; 1532-8198
• DOI: 10.1016/j.anndiagpath.2010.02.004

Abstract Biliary papillomatosis and papillary carcinoma are rare tumors of biliary tract; and because of their morphologic similarities, papillomatosis-papillary carcinoma sequel has been proposed. We report an unusual case of polypoid minimally invasive papillary carcinoma located at the junction between cystic and common bile ducts, complicated with biliary papillomatosis of gallbladder and cystic duct, showing focal areas of malignant change. Intrahepatic ducts, hepatic ducts, and distal common bile duct were spared. Both papillomatosis and papillary carcinoma showed areas of high p53 and p21 expression with high proliferative index. Patient is still alive for 4 years without evidence of disease after modified Whipple operation. Possible pathogenetic mechanisms are further discussed.