Benign tumors of the biliary system primarily include benign lesions of the gallbladder and bile ducts, with benign bile duct tumors being rare.
Pathology
The most common benign tumor of the gallbladder is gallbladder adenoma. Other lesions include adenomyomatosis, cholesterol polyps, inflammatory polyps, and hyperplastic polyps.
Clinical Manifestations
Benign gallbladder tumors are often asymptomatic and are typically discovered incidentally during ultrasound examinations. Some patients may experience upper abdominal discomfort or loss of appetite, and physical examination may reveal tenderness in the right upper quadrant. Benign bile duct tumors are more common in middle-aged and elderly individuals, with similar incidence rates in males and females. Symptoms may include biliary obstruction, secondary infections, or biliary bleeding.
Diagnosis
Abdominal ultrasound is the primary diagnostic tool, but it may not reliably determine the nature of the lesion. Additional diagnostic methods include:
- Conventional ultrasound combined with color Doppler ultrasound or contrast-enhanced ultrasound;
- Endoscopic ultrasound (EUS);
- Contrast-enhanced CT scans;
- Ultrasound-guided percutaneous fine-needle aspiration biopsy.
Endoscopic retrograde cholangiopancreatography (ERCP) is valuable for locating the site of biliary obstruction and can also help determine the nature of the lesion.
Treatment
For benign gallbladder tumors larger than 10 mm, the risk of malignancy increases, and surgical removal of the gallbladder is recommended. Cholecystectomy may also be considered for polypoid lesions that are symptomatic or for lesions measuring 6–9 mm in size with risk factors for malignancy.