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- W2978312160 abstract "Figure: No Caption available.Case: A 39-year-old Caucasian female presented with abdominal pain, nausea/vomiting, and jaundice. Abdominal CT scan revealed findings of type IVa choledochal cyst. There were enhancing lesions within the cyst suspicious for cholangiocacinoma. An ERCP with cholangioscopy confi rmed the presence of choledochal cyst, and showed finger like growth in the common hepatic and right hepatic ducts. Cholangioscopic biopsies showed papillary adenoma with high grade dysplasia (HGD). She underwent en-bloc extra hepatic bile duct resection, right hepatectomy, cholecystectomy, Roux-en-Y reconstruction with hepaticojejunostomy, and portal lymphadenectomy. Surgical pathology showed multifocal, moderately differentiated invasive adenocarcinoma, in a background of papillary adenoma and biliary dysplasia. The surgical margins, and the excised lymph nodes were negative for malignancy (pT1, pN0). Patient returned for endoscopic surveillance 17 months after above surgery. A direct cholangioscopy was performed with a pediatric colonoscope. The hepaticojejunostomy anastomosis was reached and the scope was advanced into the left main intrahepatic duct and its first bifurcation. Careful endoscopic examination was performed with white light and narrow-band imaging (NBI). An area of abnormal mucosa with tuft of papillary projections was seen in the left hepatic duct. Multiple targeted biopsies were obtained from this area. Exam of the abnormal mucosa with NBI highlighted the dark mucosa and prominent vasculature in the papillary projections. Although NBI exam did not show gross abnormalities in other areas of the bile ducts, the mucosa appeared speckled and blue, and there was prominent vascular pattern compared to the adjacent jejunal mucosa. Multiple random biopsies were also obtained from the hepatic ducts. Targeted biopsies from papillary projections showed high grade dysplasia (HGD). Random biopsies from areas without any obvious lesions also showed HGD in a background of intestinal metaplasia. Discussion: This case highlights the risk of HGD and malignancy in unresected, but dilated biliary ducts in the setting of choledochal cyst. There are no specific guidelines regarding surveillance protocol for these patients. Continued endoscopic surveillance should be considered. Liver transplantation may be a curative option. Our patient is currently being evaluated for liver transplant. White light endoscopy is limited in recognizing dysplastic biliary epithelium. Random biopsies from normal appearing mucosa should be done in addition to targeted biopsies. Our case demonstrates NBI appearance of biopsy proven HGD in biliary system. We speculate that NBI may have a role in evaluating dysplastic biliary epithelium." @default.
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- W2978312160 date "2013-10-01" @default.
- W2978312160 modified "2023-09-26" @default.
- W2978312160 title "Narrow-band Imaging (NBI) Appearance of High-grade Dysplasia in Bile Ducts" @default.
- W2978312160 doi "https://doi.org/10.14309/00000434-201310001-02155" @default.
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