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agnostic workup because of elevated serum liver enzyme levels (γ-glutamyltransferase 53.94 μkat/L, reference range 0.00–0.63). A transabdominal ultrasound revealed dilated extrahepatic bile ducts, and on endoscopic ultrasound (EUS) the common bile duct (CBD) was dilated with hyperechoic fociwith no acoustic shadowing within, and a 20-mm hyperechoic frond-like mass was noted within the infundibulum of gallbladder (●" Fig. 1). The CBD and gallbladder walls were thin with smooth outer margins. Endoscopic retrograde cholangiography (ERC) revealed a 15-mm long filling defect within the dilated CBD (●" Fig. 2). A biopsy sample taken from the CBD showed evidence of tubulopapillary adenomawith foci of well-differentiated adenocarcinoma. An abdominal computed tomography (CT) scan showed atypical, but noncontrast-enhancing, hyperdense structures within the gallbladder infundibulum,whichwere not suggestive of tumor (●" Fig. 3). The patient underwent open laparotomy, cholecystectomy, and extensive resection of the extrahepatic bile ducts with Roux-en-Y hepaticojejunostomy. The histological examination confirmed the diagnosis of papillomatosis of the extrahepatic bile ducts, with foci of high-grade dysplasia (●" Fig. 4) and secondary growth extending into the gallbladder along the cystic duct. Biliary papillomatosis (BP) is a rare disease characterized by the presence of numerous papillary adenomas within the intraand/or extrahepatic biliary tree, with or without mucin hypersecretion [1]. It is a premalignant condition, undergoing malignant transformation in 25–50% of cases [1]. The diagnosis is based on histological examination of specimens obtained during ERC, cholangioscopy, or surgery. Papillary carcinoma, whichmanifests as awelldefined, polypoid mass obstructing the lumen of a single extrahepatic bile duct and as a single filling defect on ERC, should be distinguished frommulticentric biliary papillomatosis. Papillomatosis of the extrahepatic bile ducts and gallbladder diagnosed by endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP)

endoscopy

Papillomatosis of the extrahepatic bile ducts and gallbladder diagnosed by endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP)