Part 1: Case report

A 65-year-old man was referred for assessment of advanced liver disease. Seventeen years previously he had been diagnosed with ulcerative colitis, and 7 years later with primary sclerosing cholangitis (PSC). After several episodes with variceal bleeding caused by secondary biliary cirrhosis, a transjugular intrahepatic portosystemic shunt (TIPS) was created. Because of recurrent bacterial cholangitis, endoscopic retrograde cholangiography was performed, showing irregular narrowing of the intrahepatic bile ducts with saccular dilatations, findings considered compatible with PSC (figure 1). Also, a round filling defect in the common bile duct (CBD) was noted. After biliary sphincterotomy, a 6 mm polyp was removed. Histopathology review revealed a papillary adenoma with low-grade dysplasia.