A CASE OF PAPILLARY ADENOMA OF THE LOWER BILE DUCT

A 65-year-old man complaining of right upper quadrant discomfort and fever was seen at the hospital. Serum T. Bil. and transaminases were elevated. Abdominal ultrasonography and CT showed a dilatation of the common bile duct, but no apparent stones or tumors were seen. ERCP revealed a round filling defect in the lower bile duct. A diagnosis of choledocholithiasis was made, and a laparotomy was performed. Choledochotomy and intraoperative cholangioscopy failed to reveal any gallstones, but a papillary tumor was found in the lower bile duct. The histological diagnosis of a biopsy specimen of the tumor was papillary adenoma, and a pylorus-preserving pancreatoduodenectomy was performed. Histological examination of the resected mate-rial showed benign papillary adenoma without invasion or lymph node metastasis. Although benign tumors of the extrahepatic bile ducts are rare, there have been a case of cancer in ade-noma of the lower bile duct and a case of recurrence of lower bile duct adenoma following local resection in the Japanese literature. Thus, we think that adenoma of the bile duct should be resected radically.